Healthcare Provider Details

I. General information

NPI: 1407215957
Provider Name (Legal Business Name): ALLISON LEASURE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 PINEMIRE DR
OVIEDO FL
32765-6094
US

IV. Provider business mailing address

PO BOX 742036
ATLANTA GA
30384-2036
US

V. Phone/Fax

Practice location:
  • Phone: 407-542-1733
  • Fax: 407-542-1740
Mailing address:
  • Phone: 904-697-3610
  • Fax: 904-697-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9331407
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9331407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: