Provider Demographics
NPI:1518777531
Name:LEO, MARGUERITHE
Entity type:Individual
Prefix:
First Name:MARGUERITHE
Middle Name:
Last Name:LEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9639
Mailing Address - Country:US
Mailing Address - Phone:678-918-1330
Mailing Address - Fax:
Practice Address - Street 1:549 SKY HARBOR DR BLDG 31
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3930
Practice Address - Country:US
Practice Address - Phone:727-724-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily