Healthcare Provider Details

I. General information

NPI: 1669563151
Provider Name (Legal Business Name): LEIGH ANN TABOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH ANN TABOR ARNP-C

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 LAKE ELLENOR DR SUITE 105
ORLANDO FL
32809-4616
US

IV. Provider business mailing address

6101 LAKE ELLENOR DR SUITE 105
ORLANDO FL
32809-4616
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-8645
  • Fax: 407-322-8725
Mailing address:
  • Phone: 407-322-8645
  • Fax: 407-322-8725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9180329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: