Provider Demographics
NPI:1487279550
Name:TATE, LESLIE ROSE (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ROSE
Last Name:TATE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:KWIATKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4 ATLANTIC ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2350
Mailing Address - Country:US
Mailing Address - Phone:202-540-9857
Mailing Address - Fax:
Practice Address - Street 1:2120 BLADENSBURG RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1440
Practice Address - Country:US
Practice Address - Phone:202-540-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC200004031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily