Healthcare Provider Details

I. General information

NPI: 1144776790
Provider Name (Legal Business Name): LEAH ELIZABETH ACKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 SE OCEAN BLVD
STUART FL
34996
US

IV. Provider business mailing address

2221 SE OCEAN BLVD
STUART FL
34996
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-4428
  • Fax: 772-600-1719
Mailing address:
  • Phone: 772-283-4428
  • Fax: 772-600-1719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9338239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: