MEDICARE: MRS. KAITLIN ESTOCK LEIVA APRN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11008828	FL
2	363L00000X	Nurse Practitioner	APRN11008828	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336746536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAITLIN ESTOCK LEIVA APRN-C

Provider Business Mailing Address
First Line	:	1988 GULF TO BAY BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3550
Country	:	US
Telephone Number	:	727-314-4243
Fax Number	:	813-635-2613

Provider Business Practice Location Address
First Line	:	2803 W SAINT ISABEL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6343
Country	:	US
Telephone Number	:	813-253-2273
Fax Number	:	813-253-2279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	02/08/2024

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