Provider Demographics
NPI:1912904095
Name:ISALY, LEANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:
Last Name:ISALY
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 1:5514 CARBINE CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1209
Mailing Address - Country:US
Mailing Address - Phone:727-375-5846
Mailing Address - Fax:727-862-2182
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7180
Practice Address - Country:US
Practice Address - Phone:727-862-3202
Practice Address - Fax:727-862-2182
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2789672363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
S65182Medicare UPIN
E1349YMedicare ID - Type Unspecified