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General NPI Number Information
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NPI Number | 1356966584
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Entity Type | Individual
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Provider Name | WILLIAM LEDESMA NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 700 NW 30TH AVE
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City | OCALA
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State | FL
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Zip | 34475-5606
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Country | US
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Telephone | 352-425-2747
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 SW 62ND ST
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City | OCALA
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State | FL
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Zip | 34474-5610
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Country | US
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Telephone | 352-425-2747
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11007543
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License Number State | FL
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