Healthcare Provider Details

I. General information

NPI: 1306313523
Provider Name (Legal Business Name): LEAH NICOLE CATULLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SE CARDINAL TRL
STUART FL
34997-7304
US

IV. Provider business mailing address

938 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2816
US

V. Phone/Fax

Practice location:
  • Phone: 561-319-6736
  • Fax:
Mailing address:
  • Phone: 772-221-7620
  • Fax: 772-221-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9497933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: