Provider Demographics
NPI:1780451310
Name:PINO, LEIDYS (FNP-BC)
Entity type:Individual
Prefix:
First Name:LEIDYS
Middle Name:
Last Name:PINO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 SW 67TH AVE APT 1011
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1117
Mailing Address - Country:US
Mailing Address - Phone:786-294-7356
Mailing Address - Fax:
Practice Address - Street 1:8650 SW 67TH AVE APT 1011
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1117
Practice Address - Country:US
Practice Address - Phone:786-294-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily