Provider Demographics
NPI:1164555835
Name:HURDLE-LEAKE, SONYA JOY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:JOY
Last Name:HURDLE-LEAKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SONYA
Other - Middle Name:HURDLE
Other - Last Name:LEAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 HEART DR
Practice Address - Street 2:EAST CAROLINA HEART INSTITUTE @ ECU
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8944
Practice Address - Country:US
Practice Address - Phone:252-744-4400
Practice Address - Fax:252-744-3987
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC125229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005749Medicaid
NCNC40650988Medicare PIN