Provider Demographics
NPI:1801874987
Name:TOWNSEND, LEATRICE IONE (ARNP)
Entity type:Individual
Prefix:
First Name:LEATRICE
Middle Name:IONE
Last Name:TOWNSEND
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 1:2707 SPRING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-9619
Mailing Address - Country:US
Mailing Address - Phone:813-638-2261
Mailing Address - Fax:
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9211311363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY088QOtherBLUE CROSS BLUE SHIELD
ME000201030Medicaid
FL307403000Medicaid
FLP64611Medicare UPIN
FL307403000Medicaid
ME000201030Medicaid
FLY088QOtherBLUE CROSS BLUE SHIELD