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General NPI Number Information
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NPI Number | 1295482693
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Entity Type | Individual
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Provider Name | NICHOLAS LEGGO
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Gender | Male
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3469 W BOYNTON BEACH BLVD STE 18
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4639
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Country | US
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Telephone | 561-576-9404
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Fax |
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Provider Business Mailing Address
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Address Line | 2046 ALTA MEADOWS LN APT 1903
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City | DELRAY BEACH
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State | FL
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Zip | 33444-1176
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Country | US
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Telephone |
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11033691
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License Number State | FL
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