Provider Demographics
NPI:1679047716
Name:JAMES, LEONA CLAIRE (LEONA)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:CLAIRE
Last Name:JAMES
Suffix:
Gender:F
Credentials:LEONA
Other - Prefix:
Other - First Name:LEONA
Other - Middle Name:CLAIRE
Other - Last Name:BRAITHWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 SW YAGER PL
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5468
Mailing Address - Country:US
Mailing Address - Phone:772-812-9749
Mailing Address - Fax:
Practice Address - Street 1:221 SW YAGER PL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5468
Practice Address - Country:US
Practice Address - Phone:772-812-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility