MEDICARE: DR. LESLIE DAWN ROSENBERG APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP3004482	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3004480	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	:	1962425546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE DAWN ROSENBERG APRN

Provider Business Mailing Address
First Line	:	280 CHILD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-0001
Country	:	US
Telephone Number	:	904-270-4280
Fax Number	:	904-270-4456

Provider Business Practice Location Address
First Line	:	2104 MASSEY AVE.
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32228
Country	:	US
Telephone Number	:	904-270-4280
Fax Number	:	904-270-4456

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/25/2025

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