Provider Demographics
NPI:1295357424
Name:DE LEON, RUBEN A (APRN)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:A
Last Name:DE LEON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 CAPITAL CIR NE STE 9
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4486
Mailing Address - Country:US
Mailing Address - Phone:888-698-2714
Mailing Address - Fax:888-698-2714
Practice Address - Street 1:1891 CAPITAL CIR NE STE 9
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4486
Practice Address - Country:US
Practice Address - Phone:888-698-2714
Practice Address - Fax:888-698-2714
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008015363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner