Provider Demographics
NPI:1922515311
Name:MORENO, LESLIE B (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:B
Last Name:MORENO
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:B
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, FNP- BC
Mailing Address - Street 1:6750 SW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1751 BONAVENTURE BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4039
Practice Address - Country:US
Practice Address - Phone:954-656-3181
Practice Address - Fax:954-656-3188
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9325959363LF0000X
FLAPRN9325959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily