Provider Demographics
NPI:1831661214
Name:CAMPOS, LEANNE (FNP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:CAMPOS
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 1:5130 N GRACIOUS CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-8900
Mailing Address - Country:US
Mailing Address - Phone:520-309-1215
Mailing Address - Fax:
Practice Address - Street 1:5130 N GRACIOUS CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-8900
Practice Address - Country:US
Practice Address - Phone:520-309-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ220635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily