Healthcare Provider Details

I. General information

NPI: 1588588628
Provider Name (Legal Business Name): LEAH MARIE NAGEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH NAGEL

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4543 S MANHATTAN AVE STE 101
TAMPA FL
33611-2330
US

IV. Provider business mailing address

4543 S MANHATTAN AVE STE 101
TAMPA FL
33611-2330
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-8100
  • Fax:
Mailing address:
  • Phone: 727-544-8100
  • Fax: 727-544-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049876
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11049876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: