Provider Demographics
NPI:1114531324
Name:PRIDE, LEANDREA
Entity Type:Individual
Prefix:
First Name:LEANDREA
Middle Name:
Last Name:PRIDE
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 1:1516 BAYWOOD VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2100
Mailing Address - Country:US
Mailing Address - Phone:352-255-4405
Mailing Address - Fax:
Practice Address - Street 1:1516 BAYWOOD VILLAGE CT
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2100
Practice Address - Country:US
Practice Address - Phone:352-255-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health