Provider Demographics
NPI:1487033882
Name:LEEBERG, TAMI (APRN)
Entity type:Individual
Prefix:MS
First Name:TAMI
Middle Name:
Last Name:LEEBERG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 BRABROOK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:FL
Mailing Address - Zip Code:32949-2130
Mailing Address - Country:US
Mailing Address - Phone:812-350-9187
Mailing Address - Fax:
Practice Address - Street 1:1344 S APOLLO BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-429-2677
Practice Address - Fax:321-456-5444
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9435838363LA2200X
IN28152144A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse