Provider Demographics
NPI:1093430688
Name:LEIVA SANTANA, MAYLETT (FNP)
Entity Type:Individual
Prefix:
First Name:MAYLETT
Middle Name:
Last Name:LEIVA SANTANA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1640
Mailing Address - Country:US
Mailing Address - Phone:305-922-9372
Mailing Address - Fax:
Practice Address - Street 1:10440 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1640
Practice Address - Country:US
Practice Address - Phone:305-922-9372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF10220274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner