Provider Demographics
NPI:1528403532
Name:LEAO, RICARDO JORGE SOUZA (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:JORGE SOUZA
Last Name:LEAO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-4707
Mailing Address - Country:US
Mailing Address - Phone:803-285-5441
Mailing Address - Fax:803-285-7509
Practice Address - Street 1:104 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4707
Practice Address - Country:US
Practice Address - Phone:803-285-5441
Practice Address - Fax:803-285-7509
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18218363LF0000X
NC225875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily