Provider Demographics
NPI:1821776923
Name:LEON, LIDISY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LIDISY
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 TANNER TER
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-6118
Mailing Address - Country:US
Mailing Address - Phone:321-299-8510
Mailing Address - Fax:
Practice Address - Street 1:9637 LAKE NONA VILLAGE PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7319
Practice Address - Country:US
Practice Address - Phone:407-723-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily