Healthcare Provider Details

I. General information

NPI: 1831779479
Provider Name (Legal Business Name): MILADYS LISTE LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E MELBOURNE AVE STE 101
MELBOURNE FL
32901-5970
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 321-312-1167
  • Fax: 321-312-1201
Mailing address:
  • Phone: 727-322-3439
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11012227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: