Provider Demographics
NPI:1336746536
Name:LEIVA, KAITLIN ESTOCK (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ESTOCK
Last Name:LEIVA
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MRS
Other - First Name:KAITLIN
Other - Middle Name:ASHLEY ESTOCK
Other - Last Name:LEIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1988 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3550
Mailing Address - Country:US
Mailing Address - Phone:727-314-4243
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:2803 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6343
Practice Address - Country:US
Practice Address - Phone:813-253-2273
Practice Address - Fax:813-253-2279
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008828363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109550400Medicaid