Provider Demographics
NPI:1790490274
Name:LEON, MARIE (PMHNP- BC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 NE 212TH TER APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1363
Mailing Address - Country:US
Mailing Address - Phone:786-991-4787
Mailing Address - Fax:
Practice Address - Street 1:840 NE 212TH TER APT 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-1363
Practice Address - Country:US
Practice Address - Phone:786-991-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023857363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11023857OtherUNITED HEALTHCARE
FL11023857OtherAETNA
FL11023857Medicaid
FL11023857OtherHUMANA
FL11023857OtherCIGNA