Provider Demographics
NPI:1376195370
Name:GAIGE, LEONARDA M (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LEONARDA
Middle Name:M
Last Name:GAIGE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N VERMONT AVE FL 33801
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-1824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6901 STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:FL
Practice Address - Zip Code:33834-9505
Practice Address - Country:US
Practice Address - Phone:863-767-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily