Healthcare Provider Details

I. General information

NPI: 1033441886
Provider Name (Legal Business Name): LEO O SOLDNER JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 EL CAMINO REAL
THE VILLAGES FL
32159-0041
US

IV. Provider business mailing address

1329 SW 16TH ST RM 2232
GAINESVILLE FL
32608-1128
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-8000
  • Fax: 352-751-8094
Mailing address:
  • Phone: 352-733-0485
  • Fax: 352-265-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number97743
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9307570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: