Provider Demographics
NPI:1245957091
Name:HOSPEDALES, LEISA JAMINE (AGPCNP-BC)
Entity type:Individual
Prefix:MS
First Name:LEISA
Middle Name:JAMINE
Last Name:HOSPEDALES
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:MS
Other - First Name:LEISA
Other - Middle Name:JAMINE
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15118 EVANS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-9714
Mailing Address - Country:US
Mailing Address - Phone:863-510-8225
Mailing Address - Fax:
Practice Address - Street 1:135 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4609
Practice Address - Country:US
Practice Address - Phone:863-686-2728
Practice Address - Fax:863-686-6737
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021939363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health