Healthcare Provider Details

I. General information

NPI: 1720325830
Provider Name (Legal Business Name): LUISA FERNANDA LEAL APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 HARDING PLACE SUITE 102
NASHVILLE TN
37211-4770
US

IV. Provider business mailing address

PO BOX 1822
MOUNT JULIET TN
37121-1822
US

V. Phone/Fax

Practice location:
  • Phone: 615-840-7994
  • Fax: 615-739-6678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number17240
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: