Provider Demographics
NPI:1356966584
Name:LEDESMA, WILLIAM (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:LEDESMA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 SW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5610
Mailing Address - Country:US
Mailing Address - Phone:352-425-2747
Mailing Address - Fax:
Practice Address - Street 1:700 NW 30TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-5606
Practice Address - Country:US
Practice Address - Phone:352-425-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily