Healthcare Provider Details

I. General information

NPI: 1487370011
Provider Name (Legal Business Name): LEANDRO ESCORCIO CORREIA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 S CHICKASAW TRL STE 203
ORLANDO FL
32825-3558
US

IV. Provider business mailing address

258 S CHICKASAW TRL
ORLANDO FL
32825-3501
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6588
  • Fax:
Mailing address:
  • Phone: 407-303-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11022458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: