Provider Demographics
NPI:1669930236
Name:LEBLANC, DANIELLE LUCIENNE (CRNA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LUCIENNE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7577 SW 87TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8763
Mailing Address - Country:US
Mailing Address - Phone:352-872-2571
Mailing Address - Fax:
Practice Address - Street 1:5380 TECH DATA DR STE 101
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3122
Practice Address - Country:US
Practice Address - Phone:727-573-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9368714367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered