Provider Demographics
NPI:1659029429
Name:KING, LEONIE C (NP)
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:C
Last Name:KING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 GATE PKWY UNIT 104-367
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2893
Mailing Address - Country:US
Mailing Address - Phone:757-842-0062
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1603
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6298
Practice Address - Country:US
Practice Address - Phone:909-047-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily