Provider Demographics
NPI:1902303225
Name:CORDERO, LEONARDO ENRIQUE (FNP)
Entity Type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:ENRIQUE
Last Name:CORDERO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 HUGH HOWELL RD
Mailing Address - Street 2:STE D
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4905
Mailing Address - Country:US
Mailing Address - Phone:700-979-3796
Mailing Address - Fax:770-979-0939
Practice Address - Street 1:2311 HENRY CLOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7418
Practice Address - Country:US
Practice Address - Phone:770-979-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN232819363L00000X, 363LF0000X
COC-APN.0101857-C-NP363LF0000X
AZ305376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner