Basic Information
Provider Information
NPI: 1174195168
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANCISCO
FirstName: LEONOR
MiddleName: EMATA
NamePrefix:  
NameSuffix:  
Credential: PMHNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11863 SW 12TH ST
Address2:  
City: PEMBROKE PINES
State: FL
PostalCode: 330255717
CountryCode: US
TelephoneNumber: 6099545641
FaxNumber:  
Practice Location
Address1: 274 MADISON AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100160701
CountryCode: US
TelephoneNumber: 2122031773
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/11/2021
LastUpdateDate: 04/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808X9388438FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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