Healthcare Provider Details

I. General information

NPI: 1114680600
Provider Name (Legal Business Name): LEONEL ANTOINE JEUNE FNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 SUN CITY CENTER BLVD
SUN CITY CENTER FL
33573-5256
US

IV. Provider business mailing address

942 ROYAL EMPRESS DR
RUSKIN FL
33570-4549
US

V. Phone/Fax

Practice location:
  • Phone: 224-425-2493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11016055
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11016055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: