Provider Demographics
NPI:1548955271
Name:ESPINOSA, LEYDI MARCELA (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:LEYDI
Middle Name:MARCELA
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 DACULA RD STE 4A310
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7061
Mailing Address - Country:US
Mailing Address - Phone:973-800-7815
Mailing Address - Fax:
Practice Address - Street 1:5855 JIMMY CARTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2984
Practice Address - Country:US
Practice Address - Phone:404-644-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17238100363LF0000X
GARN302178363LF0000X
NJPMH08240005363LP0808X
GAPMH08240005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily