Provider Demographics
NPI:1013597772
Name:LEONARD, CHARTESHIA T
Entity Type:Individual
Prefix:MS
First Name:CHARTESHIA
Middle Name:T
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SWEETGUM RD
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-4203
Mailing Address - Country:US
Mailing Address - Phone:386-538-4620
Mailing Address - Fax:
Practice Address - Street 1:110 SWEETGUM RD
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-4203
Practice Address - Country:US
Practice Address - Phone:386-538-4620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X, 251E00000X
FLPN5243094164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide
No251E00000XAgenciesHome Health