Provider Demographics
NPI:1700401387
Name:LEGARD, KAILEEN M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KAILEEN
Middle Name:M
Last Name:LEGARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9236 123RD WAY
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3229
Mailing Address - Country:US
Mailing Address - Phone:727-249-3914
Mailing Address - Fax:
Practice Address - Street 1:JAMES A. HALEY VETERANS HOSPITAL
Practice Address - Street 2:13000 BRUCE B DOWNS BLVD
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006340363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health