Healthcare Provider Details

I. General information

NPI: 1548955271
Provider Name (Legal Business Name): LEYDI MARCELA ESPINOSA DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 08/18/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 JIMMY CARTER BLVD STE 200
NORCROSS GA
30071-2984
US

IV. Provider business mailing address

710 DACULA RD STE 4A310
DACULA GA
30019-7061
US

V. Phone/Fax

Practice location:
  • Phone: 404-644-2257
  • Fax:
Mailing address:
  • Phone: 973-800-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NR17238100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN302178
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH08240005
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH08240005
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: