Provider Demographics
NPI:1346622271
Name:ATENCIO, LEONARD JAMES (FNP)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:JAMES
Last Name:ATENCIO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1920
Mailing Address - Country:US
Mailing Address - Phone:520-364-1429
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:10566 N HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:ELFRIDA
Practice Address - State:AZ
Practice Address - Zip Code:85610-9021
Practice Address - Country:US
Practice Address - Phone:520-642-2222
Practice Address - Fax:520-364-4261
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082662Medicaid