Provider Demographics
NPI:1073144606
Name:LEYVA, ILEANA LUCIA (APRN)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:LUCIA
Last Name:LEYVA
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 1:234 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5314
Mailing Address - Country:US
Mailing Address - Phone:786-554-9780
Mailing Address - Fax:
Practice Address - Street 1:234 W 31ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5314
Practice Address - Country:US
Practice Address - Phone:786-554-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPN11005582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily