Provider Demographics
NPI:1497142863
Name:OLESZKOWICZ, LESLIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:OLESZKOWICZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:COVALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:823 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-449-1010
Practice Address - Fax:843-497-6171
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1190167OtherWELLCARE
SC1190167OtherWELLCARE
NC1497142863Medicaid
SC30237547OtherSELECT HEALTH
SCP01565762OtherRR MEDICARE
SC4746306OtherAETNA
SC5637428OtherUNITED HEALTHCARE
SC80064208OtherSELECT HEALTH
SCNP3429Medicaid
NC1497142863Medicaid