Provider Demographics
NPI:1023828159
Name:COOPER SULLIVAN, LESLIE JEANETTE (FNP-C)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JEANETTE
Last Name:COOPER SULLIVAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10646 E CAROL AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-7434
Mailing Address - Country:US
Mailing Address - Phone:480-450-5999
Mailing Address - Fax:
Practice Address - Street 1:426 N 44TH ST STE 405
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6612
Practice Address - Country:US
Practice Address - Phone:602-476-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP318160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily