Healthcare Provider Details

I. General information

NPI: 1053707679
Provider Name (Legal Business Name): LEIZEL CURL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

IV. Provider business mailing address

8922 SW CAPRICE CIR
STUART FL
34997-1309
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-0304
  • Fax:
Mailing address:
  • Phone: 772-341-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3141612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: