MEDICARE: LEILA MONIQUE GAINES 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	363LA2200X	Adult Health Nurse Practitioner	26NN09759200	NJ
2	363LA2200X	Adult Health Nurse Practitioner	LP-0010411	DE
3	363LA2200X	Adult Health Nurse Practitioner	APRN11024942	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	:	1861596405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA MONIQUE GAINES APRN-C

Provider Business Mailing Address
First Line	:	787 CORTARO DR
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6812
Country	:	US
Telephone Number	:	813-634-2500
Fax Number	:	813-634-3008

Provider Business Practice Location Address
First Line	:	787 CORTARO DR
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6812
Country	:	US
Telephone Number	:	813-634-2500
Fax Number	:	813-634-3008

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	01/06/2025

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