Provider Demographics
NPI:1386818797
Name:LEAMON, DEANNA TINA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:TINA
Last Name:LEAMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:DEANNA
Other - Middle Name:TINA
Other - Last Name:GRASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:965 E YOSEMITE AVE
Practice Address - Street 2:STE 2
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5938
Practice Address - Country:US
Practice Address - Phone:209-239-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily