Provider Demographics
NPI:1265426779
Name:DELEONARD, MARCIA MARIA (MSN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:MARIA
Last Name:DELEONARD
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MRS
Other - First Name:MARCIA
Other - Middle Name:MARIA
Other - Last Name:MEEKER/MCCUTCHEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:41 OVERLOOK CIR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38558-4012
Mailing Address - Country:US
Mailing Address - Phone:931-456-8517
Mailing Address - Fax:
Practice Address - Street 1:302 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5210
Practice Address - Country:US
Practice Address - Phone:866-289-2727
Practice Address - Fax:612-767-1911
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22121Medicare UPIN