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General NPI Number Information
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NPI Number | 1730900879
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Entity Type | Individual
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Provider Name | LEICY EMERSON AGACNP- BC
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 7322 SW 162ND PL
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City | MIAMI
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State | FL
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Zip | 33193-4416
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Country | US
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Telephone | 786-332-8121
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Fax |
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Provider Business Mailing Address
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Address Line | 7322 SW 162ND PL
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City | MIAMI
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State | FL
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Zip | 33193-4416
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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 | 364SA2100X
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Taxonomy Name | Acute Care Clinical Nurse Specialist
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License Number | 2024068293
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License Number State | FL
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