Provider Demographics
NPI:1952057416
Name:SAWICKI, LEA SAMANTHA
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:SAMANTHA
Last Name:SAWICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 SW 72ND AVE APT 426
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7666
Mailing Address - Country:US
Mailing Address - Phone:305-546-9894
Mailing Address - Fax:
Practice Address - Street 1:8390 SW 72ND AVE APT 426
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7666
Practice Address - Country:US
Practice Address - Phone:305-546-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018335363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care