Provider Demographics
NPI:1356105662
Name:LEAMAN, CEDAR CASIDY
Entity type:Individual
Prefix:
First Name:CEDAR
Middle Name:CASIDY
Last Name:LEAMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8879 FALCON POINTE LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1472
Mailing Address - Country:US
Mailing Address - Phone:303-913-8996
Mailing Address - Fax:
Practice Address - Street 1:8879 FALCON POINTE LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1472
Practice Address - Country:US
Practice Address - Phone:303-913-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily