Basic Information
| Provider Information | |||||||||
| NPI: | 1750847976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERRY | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4837 STATE ROUTE 40 | ||||||||
| Address2: | |||||||||
| City: | ARGYLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128093469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632327072 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19021 N DALE MABRY HWY | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139615201 | ||||||||
| FaxNumber: | 8133771685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2019 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11001016 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.