Provider Demographics
NPI:1972865533
Name:LETO, HEATHER LYNN (ARNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:LETO
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3911
Mailing Address - Country:US
Mailing Address - Phone:813-978-1500
Mailing Address - Fax:813-978-1210
Practice Address - Street 1:12500 N DALE MABRY HWY STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2809
Practice Address - Country:US
Practice Address - Phone:813-712-5702
Practice Address - Fax:813-377-1005
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9205170363LF0000X
FLAPRN9205170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0C2JOtherBLUE CROSS BLUE SHIELD
FL008654200Medicaid
FLGG506TMedicare PIN
FL008654200Medicaid