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General NPI Number Information
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NPI Number | 1134203227
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Entity Type | Individual
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Provider Name | MARY ALICE MACKENZIE LEINBACH ARNP, CPNP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 615 E PRINCETON ST SUITE 310
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City | ORLANDO
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State | FL
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Zip | 32803-1456
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Country | US
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Telephone | 407-898-2767
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Fax | 407-898-9443
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Provider Business Mailing Address
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Address Line | 1336 TWIN RIVERS BLVD
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City | OVIEDO
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State | FL
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Zip | 32766-5081
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Country | US
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Telephone | 321-961-4325
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Fax | 407-898-9443
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | ARNP9212933
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License Number State | FL
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