Provider Demographics
NPI:1962561647
Name:LEON, MICHELLE G (APRN 1896212)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:G
Last Name:LEON
Suffix:
Gender:F
Credentials:APRN 1896212
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:GRACE
Other - Last Name:BINNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4825 SW 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330
Mailing Address - Country:US
Mailing Address - Phone:954-294-8678
Mailing Address - Fax:954-832-0063
Practice Address - Street 1:4825 SW 148TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330
Practice Address - Country:US
Practice Address - Phone:954-990-6901
Practice Address - Fax:954-832-0063
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNP1896212363L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300722700Medicaid
FL300722700Medicaid
FLE2586ZMedicare PIN