Provider Demographics
NPI:1437589801
Name:EASLEY, LEO II (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:EASLEY
Suffix:II
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6016
Mailing Address - Country:US
Mailing Address - Phone:520-498-3900
Mailing Address - Fax:520-544-7542
Practice Address - Street 1:5840 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3537
Practice Address - Country:US
Practice Address - Phone:520-498-3900
Practice Address - Fax:520-544-7542
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR727598363LF0000X
AZAP10544363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily