Provider Demographics
NPI:1902688666
Name:FREEDOM FAMILY PRACTICE
Entity Type:Organization
Organization Name:FREEDOM FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:SR
Authorized Official - Credentials:RN
Authorized Official - Phone:813-355-6675
Mailing Address - Street 1:4909 DRAWDY RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33567-8629
Mailing Address - Country:US
Mailing Address - Phone:813-355-6675
Mailing Address - Fax:
Practice Address - Street 1:4909 DRAWDY RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33567-8629
Practice Address - Country:US
Practice Address - Phone:813-355-6675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty