Provider Demographics
NPI:1720431075
Name:HARRIS, LESLIE PATRICIA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:PATRICIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7046 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4723
Mailing Address - Country:US
Mailing Address - Phone:352-733-1770
Mailing Address - Fax:352-372-5164
Practice Address - Street 1:7046 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4723
Practice Address - Country:US
Practice Address - Phone:352-733-1770
Practice Address - Fax:352-372-5164
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9233361363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018679500Medicaid
FLIS097ZMedicare PIN