Healthcare Provider Details

I. General information

NPI: 1124529193
Provider Name (Legal Business Name): CYNTHIA LEO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13067 TELECOM PARKWAY N
TEMPLE TERRACE FL
33637
US

IV. Provider business mailing address

13067 TELECOM PARKWAY N
TEMPLE TERRACE FL
33637
US

V. Phone/Fax

Practice location:
  • Phone: 813-779-6303
  • Fax: 813-977-1998
Mailing address:
  • Phone: 813-779-6303
  • Fax: 813-977-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9317266
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9317266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: