Healthcare Provider Details

I. General information

NPI: 1891608535
Provider Name (Legal Business Name): LEROY NEIL NEMBHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 SW 40TH ST
OCALA FL
34474-9595
US

IV. Provider business mailing address

5580 SW 40TH ST
OCALA FL
34474-9595
US

V. Phone/Fax

Practice location:
  • Phone: 863-845-0008
  • Fax:
Mailing address:
  • Phone: 863-845-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11051124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: