Provider Demographics
NPI:1912531799
Name:SISTRAT, LEONIE ANN (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:ANN
Last Name:SISTRAT
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3512
Mailing Address - Country:US
Mailing Address - Phone:786-261-5851
Mailing Address - Fax:
Practice Address - Street 1:817 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-5621
Practice Address - Country:US
Practice Address - Phone:954-785-8285
Practice Address - Fax:954-784-2756
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9314737363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health