Provider Demographics
NPI:1518458165
Name:LEONARD, SEAN PATRICK (AGPCNP)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PATRICK
Last Name:LEONARD
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6464
Mailing Address - Country:US
Mailing Address - Phone:562-665-6654
Mailing Address - Fax:949-606-9313
Practice Address - Street 1:1166 SAGEWOOD DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6464
Practice Address - Country:US
Practice Address - Phone:562-665-6654
Practice Address - Fax:949-606-9313
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009094363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner