Provider Demographics
NPI:1184059321
Name:MALLETT, LESLEY (ARNP)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:MALLETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:MANGANELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:13163 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773
Mailing Address - Country:US
Mailing Address - Phone:727-228-7000
Mailing Address - Fax:727-223-3614
Practice Address - Street 1:13163 66TH ST N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773
Practice Address - Country:US
Practice Address - Phone:727-228-7000
Practice Address - Fax:727-223-3614
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9368654363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009555900Medicaid