Provider Demographics
NPI:1396715561
Name:D'AMATO-KUBIET, LESLEE A (APRN)
Entity type:Individual
Prefix:DR
First Name:LESLEE
Middle Name:A
Last Name:D'AMATO-KUBIET
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 1:5 CEDARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8947
Mailing Address - Country:US
Mailing Address - Phone:386-864-1893
Mailing Address - Fax:
Practice Address - Street 1:150 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5997
Practice Address - Country:US
Practice Address - Phone:386-586-1500
Practice Address - Fax:386-586-1510
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2149972363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health