Provider Demographics
NPI:1417121633
Name:MARKLUND, LEROY ANSELM (ARNP)
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:ANSELM
Last Name:MARKLUND
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NW 10TH AVE
Mailing Address - Street 2:US ATTC SUITE T-215
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1018
Mailing Address - Country:US
Mailing Address - Phone:305-585-1852
Mailing Address - Fax:
Practice Address - Street 1:7797 NW 114TH PATH
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1383
Practice Address - Country:US
Practice Address - Phone:305-807-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16422363LA2100X
CA2685364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care