Provider Demographics
NPI:1477021384
Name:LEYVA SOUTO, GREYTE (APRN)
Entity Type:Individual
Prefix:
First Name:GREYTE
Middle Name:
Last Name:LEYVA SOUTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 NW 4TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7639
Mailing Address - Country:US
Mailing Address - Phone:754-422-5262
Mailing Address - Fax:
Practice Address - Street 1:1225 NW 40TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5801
Practice Address - Country:US
Practice Address - Phone:954-615-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily