Provider Demographics
NPI:1821664319
Name:WILLEY, LEIGH SUZANNE (APRN)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:SUZANNE
Last Name:WILLEY
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 1:5711 GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-3013
Mailing Address - Country:US
Mailing Address - Phone:770-866-7314
Mailing Address - Fax:
Practice Address - Street 1:5711 GARDENS DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-3013
Practice Address - Country:US
Practice Address - Phone:770-866-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009045363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care