Provider Demographics
NPI:1780980573
Name:NOVA, LEIGH ANN (PA-C)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:NOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 N COURTENAY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4852
Mailing Address - Country:US
Mailing Address - Phone:321-784-8211
Mailing Address - Fax:
Practice Address - Street 1:595 N COURTENAY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4852
Practice Address - Country:US
Practice Address - Phone:321-784-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical