=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386939452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES F LEITERA NURSE PRACTITIONER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2011
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 S 23RD ST STE 1
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34950-4830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-735-1178
-----------------------------------------------------
Fax | 772-223-6354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3627 SW SUNSET TRACE CIR
-----------------------------------------------------
City | PALM CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34990-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-971-3329
-----------------------------------------------------
Fax | 772-223-6354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN9486122
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN9486122
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------