Provider Demographics
NPI:1417687823
Name:BOS, LEIGHA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:LEIGHA
Middle Name:MARIE
Last Name:BOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEIGHA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7992 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-4448
Mailing Address - Country:US
Mailing Address - Phone:612-961-9797
Mailing Address - Fax:
Practice Address - Street 1:140 BIRCH ST N STE 104
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1547
Practice Address - Country:US
Practice Address - Phone:612-961-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9462363LF0000X
FL11020273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily