Provider Demographics
NPI:1366680241
Name:LEOGRANDE, MAUREEN MICHELLE (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MICHELLE
Last Name:LEOGRANDE
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE155
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-338-0700
Mailing Address - Fax:561-362-9960
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:SUITE155
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-338-0700
Practice Address - Fax:561-362-9960
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9180945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily