Provider Demographics
NPI:1134203227
Name:LEINBACH, MARY ALICE MACKENZIE (ARNP, CPNP)
Entity type:Individual
Prefix:MS
First Name:MARY ALICE
Middle Name:MACKENZIE
Last Name:LEINBACH
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 TWIN RIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-5081
Mailing Address - Country:US
Mailing Address - Phone:321-961-4325
Mailing Address - Fax:407-898-9443
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-898-2767
Practice Address - Fax:407-898-9443
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9212933363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics