Provider Demographics
NPI:1407935265
Name:LEETE, DENISE C (ARNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:C
Last Name:LEETE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4511
Mailing Address - Country:US
Mailing Address - Phone:850-763-8000
Mailing Address - Fax:850-785-1122
Practice Address - Street 1:2103 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4511
Practice Address - Country:US
Practice Address - Phone:850-763-8000
Practice Address - Fax:850-785-1122
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1814292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308385300Medicaid
FL308385300Medicaid