Provider Demographics
NPI:1447767678
Name:LING, LESLIE (CNM, NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LING
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:HENRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LESLIE LING, CNM, NP
Mailing Address - Street 1:113 ARNAU CT
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8873
Mailing Address - Country:US
Mailing Address - Phone:619-252-0633
Mailing Address - Fax:
Practice Address - Street 1:16821 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2405
Practice Address - Country:US
Practice Address - Phone:768-953-6534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764298163W00000X
HI67435163W00000X
FL11009827367A00000X, 363LW0102X
FL9552171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health