Healthcare Provider Details

I. General information

NPI: 1265374094
Provider Name (Legal Business Name): LEIDY NATACHA GIL VERGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 CITRUS OAK LN FL 34771
SAINT CLOUD FL
34771-8906
US

IV. Provider business mailing address

4845 CITRUS OAK LN FL 34771
SAINT CLOUD FL
34771-8906
US

V. Phone/Fax

Practice location:
  • Phone: 407-979-6924
  • Fax: 407-979-6924
Mailing address:
  • Phone: 407-979-6924
  • Fax: 407-979-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: