Provider Demographics
NPI:1932660396
Name:WORTH, LESLIE (HAS)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:WORTH
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 VETERANS PARK DR STE 1201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0500
Mailing Address - Country:US
Mailing Address - Phone:239-592-7212
Mailing Address - Fax:
Practice Address - Street 1:1879 VETERANS PARK DR STE 1201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0500
Practice Address - Country:US
Practice Address - Phone:239-592-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5428174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist