Healthcare Provider Details

I. General information

NPI: 1437982386
Provider Name (Legal Business Name): LEANDRA OGDEN-FUENTES MSN, APRN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16320 SW 71ST TER
MIAMI FL
33193-4499
US

IV. Provider business mailing address

16320 SW 71ST TER
MIAMI FL
33193-4499
US

V. Phone/Fax

Practice location:
  • Phone: 305-951-2444
  • Fax:
Mailing address:
  • Phone: 305-951-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9250908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: