Healthcare Provider Details

I. General information

NPI: 1417121633
Provider Name (Legal Business Name): LEROY ANSELM MARKLUND ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7797 NW 114TH PATH
MEDLEY FL
33178-1383
US

IV. Provider business mailing address

1800 NW 10TH AVE US ATTC SUITE T-215
MIAMI FL
33136-1018
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-0045
  • Fax:
Mailing address:
  • Phone: 305-585-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number16422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number2685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: