Provider Demographics
NPI:1205384765
Name:SILVA MULLER LEITE, JAQUELINE (APRN)
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:SILVA MULLER LEITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAQUELINE
Other - Middle Name:
Other - Last Name:CARVALHO DA SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 QUEEN PALM CT
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15811 AMBAUM BLVD SW STE 11015811
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3066
Practice Address - Country:US
Practice Address - Phone:206-242-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9353794363LF0000X, 363LP0808X
KY3016047363LF0000X
MN9211363LF0000X
TX1054092363LF0000X
NC5014815363LF0000X
WI11038-33363LF0000X
COC-APN.0004449-C-NP363LP0808X
AZ281976363LP0808X
OR202214950NP-PP363LP0808X
IL277002155363LP0808X
WAAP61347302363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily