MEDICARE: KATHERINE PENNY LEONARD ARNP

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	124329	AR
2	363LF0000X	Family Nurse Practitioner	APRN3139742	FL
3	363L00000X	Nurse Practitioner	APRN3139742	FL
4	363LF0000X	Family Nurse Practitioner	3139742	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	FL	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1366965519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE PENNY LEONARD ARNP

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-1981
Fax Number	:	321-951-7408

Provider Business Practice Location Address
First Line	:	7227 N US HIGHWAY 1 STE 100
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-5034
Country	:	US
Telephone Number	:	321-637-1595
Fax Number	:

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/26/2021

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Directions to “ KATHERINE PENNY LEONARD ARNP” Practice Location

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