Healthcare Provider Details

I. General information

NPI: 1629744701
Provider Name (Legal Business Name): LESLIE CUESTA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13224 SW 144TH TER
MIAMI FL
33186-7640
US

IV. Provider business mailing address

13224 SW 144TH TER
MIAMI FL
33186-7640
US

V. Phone/Fax

Practice location:
  • Phone: 305-803-1709
  • Fax:
Mailing address:
  • Phone: 305-803-1709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11010705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: