Provider Demographics
NPI:1184247157
Name:LEBOSADA, JOANNE CARIDAD BLANCO (MSN, APRN-C, FNP)
Entity type:Individual
Prefix:
First Name:JOANNE CARIDAD
Middle Name:BLANCO
Last Name:LEBOSADA
Suffix:
Gender:F
Credentials:MSN, APRN-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 SW 62ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4786
Mailing Address - Country:US
Mailing Address - Phone:352-216-2968
Mailing Address - Fax:
Practice Address - Street 1:4707 SW 62ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4786
Practice Address - Country:US
Practice Address - Phone:352-216-2968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily