Provider Demographics
NPI:1518301050
Name:LEONE, JASON ANTHONY (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANTHONY
Last Name:LEONE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:ANTHONY
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:5207 HICKORY PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2624
Mailing Address - Country:US
Mailing Address - Phone:804-612-2980
Mailing Address - Fax:804-762-7102
Practice Address - Street 1:5207 HICKORY PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2624
Practice Address - Country:US
Practice Address - Phone:804-612-2980
Practice Address - Fax:804-762-7102
Is Sole Proprietor?:No
Enumeration Date:2013-04-27
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN