Provider Demographics
NPI:1114009750
Name:AVREN, LEON ISIDORE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:ISIDORE
Last Name:AVREN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 BARCARMIL WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-0903
Mailing Address - Country:US
Mailing Address - Phone:239-265-3391
Mailing Address - Fax:239-310-2035
Practice Address - Street 1:936 BARCARMIL WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-0903
Practice Address - Country:US
Practice Address - Phone:239-265-3391
Practice Address - Fax:239-310-2035
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL861079312OtherTAX ID
FLS96906Medicare UPIN
FLE3513YMedicare PIN