Healthcare Provider Details

I. General information

NPI: 1255264966
Provider Name (Legal Business Name): PRACTITIONERS IN MOTION OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 WAVERLY PL STE A
MELBOURNE FL
32901-4641
US

IV. Provider business mailing address

1785 WAVERLY PL STE A
MELBOURNE FL
32901-4641
US

V. Phone/Fax

Practice location:
  • Phone: 321-216-2288
  • Fax:
Mailing address:
  • Phone: 321-216-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRISTI LEEBERG
Title or Position: CO OWNER
Credential: NP
Phone: 321-720-5905