Provider Demographics
NPI:1740240001
Name:ZIMMER, LEONARD J (FNP)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:J
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK ROAD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:703-914-8000
Mailing Address - Fax:703-642-1876
Practice Address - Street 1:1630 WILKES RIDGE PKWY STE 203
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7460
Practice Address - Country:US
Practice Address - Phone:703-914-8000
Practice Address - Fax:703-642-1876
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000932863BMedicaid
FLE6926ZMedicare PIN
GA000932863AMedicaid
FL3042430-00Medicaid