Provider Demographics
NPI:1013522242
Name:PAPPAS, LETICIA LEE (APRN)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:LEE
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 S ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-7143
Mailing Address - Country:US
Mailing Address - Phone:386-601-1276
Mailing Address - Fax:
Practice Address - Street 1:386 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-7143
Practice Address - Country:US
Practice Address - Phone:386-601-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9319495163W00000X
FL11010132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse