Provider Demographics
NPI:1265145932
Name:LEYVA, KENYA (APRN)
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:LEYVA
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 1:13990 BARTRAM PARK BLVD UNIT 2107
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5573
Mailing Address - Country:US
Mailing Address - Phone:786-302-9296
Mailing Address - Fax:
Practice Address - Street 1:2624 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3609
Practice Address - Country:US
Practice Address - Phone:904-513-3240
Practice Address - Fax:904-398-7871
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11023704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily