Healthcare Provider Details

I. General information

NPI: 1063643740
Provider Name (Legal Business Name): REBECCA LEYNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 COMMERCIAL WAY
SPRING HILL FL
34606-1927
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 352-592-9550
  • Fax:
Mailing address:
  • Phone: 407-875-2080
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: