Provider Demographics
NPI:1073105185
Name:LEIVA, YAHUMARA (APRN)
Entity Type:Individual
Prefix:
First Name:YAHUMARA
Middle Name:
Last Name:LEIVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 SW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4144
Mailing Address - Country:US
Mailing Address - Phone:239-245-1239
Mailing Address - Fax:
Practice Address - Street 1:1411 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3818
Practice Address - Country:US
Practice Address - Phone:239-673-6516
Practice Address - Fax:239-673-6536
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily