Provider Demographics
NPI:1750847976
Name:TERRY, LEAH MARIE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MARIE
Last Name:TERRY
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 1:4837 STATE ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809-3469
Mailing Address - Country:US
Mailing Address - Phone:863-232-7072
Mailing Address - Fax:
Practice Address - Street 1:19021 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548
Practice Address - Country:US
Practice Address - Phone:813-961-5201
Practice Address - Fax:813-377-1685
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily