Provider Demographics
NPI:1164724670
Name:CRIST, LEAH DIRIENZO (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:DIRIENZO
Last Name:CRIST
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:DIRIENZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2906 W BAY COURT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1602
Mailing Address - Country:US
Mailing Address - Phone:727-452-3398
Mailing Address - Fax:
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:727-452-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9204004363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health