MEDICARE: NEKITA LEATHERWOOD CRPS

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	175T00000X	Peer Specialist	CRPS.0102116.F	FL
2	251S00000X	Community/Behavioral Health Agency		FL

General Provider Information

NPI Number	:	1396614368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEKITA LEATHERWOOD CRPS

Provider Business Mailing Address
First Line	:	200 N LAURA ST STE 803
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3502
Country	:	US
Telephone Number	:	229-834-1098
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N LAURA ST STE 803
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3502
Country	:	US
Telephone Number	:	229-834-1098
Fax Number	:

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

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	11/07/2025

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Directions to “ NEKITA LEATHERWOOD CRPS” Practice Location

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