Healthcare Provider Details

I. General information

NPI: 1265328504
Provider Name (Legal Business Name): LEILA ANTONIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEILA LYNCH RN

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 06/14/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11651 FM 1371
CHAPPELL HILL TX
77426-5019
US

IV. Provider business mailing address

11651 FM 1371
CHAPPELL HILL TX
77426-5019
US

V. Phone/Fax

Practice location:
  • Phone: 979-277-1605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1063835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: