Provider Demographics
NPI:1780328351
Name:KENT, CHAQUERA LESHAY
Entity type:Individual
Prefix:
First Name:CHAQUERA
Middle Name:LESHAY
Last Name:KENT
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:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7473
Mailing Address - Fax:813-844-1966
Practice Address - Street 1:5 TAMPA GENERAL CIR STE 410
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3578
Practice Address - Country:US
Practice Address - Phone:813-844-7473
Practice Address - Fax:813-844-1966
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010258363LA2100X
FLAPRN11010258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care