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General NPI Number Information
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NPI Number | 1508686965
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Entity Type | Individual
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Provider Name | ELLEN R LEICHERT PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/19/2024
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Provider Practice Location Address
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Address Line | 10000 BAY PINES BOULEVARD
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City | BAY PINES
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State | FL
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Zip | 33744-8200
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Country | US
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Telephone | 727-398-6661
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Fax |
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Provider Business Mailing Address
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Address Line | 10006 BENTLEY WAY
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City | TAMPA
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State | FL
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Zip | 33626-5141
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Country | US
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Telephone | 727-967-4838
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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 | 11034247
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License Number State | FL
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