Provider Demographics
NPI:1689459281
Name:ACKERMAN, LESLIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:ACKERMAN
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:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:TRADE
Mailing Address - State:TN
Mailing Address - Zip Code:37691-0132
Mailing Address - Country:US
Mailing Address - Phone:239-290-0526
Mailing Address - Fax:
Practice Address - Street 1:440 BOW AND ARROW NVNO
Practice Address - Street 2:
Practice Address - City:TRADE
Practice Address - State:TN
Practice Address - Zip Code:37691
Practice Address - Country:US
Practice Address - Phone:239-290-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34571363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health