Provider Demographics
NPI:1316410574
Name:KAZIA, LESLIE ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:KAZIA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E FIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7828
Mailing Address - Country:US
Mailing Address - Phone:805-757-2908
Mailing Address - Fax:805-757-2908
Practice Address - Street 1:515 E FIR AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7828
Practice Address - Country:US
Practice Address - Phone:805-757-2908
Practice Address - Fax:805-757-2908
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9501825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty