Basic Information
| Provider Information | |||||||||
| NPI: | 1972865533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LETO | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13801 BRUCE B DOWNS BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336133911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139781500 | ||||||||
| FaxNumber: | 8139781210 | ||||||||
| Practice Location | |||||||||
| Address1: | 12500 N DALE MABRY HWY STE B | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336182809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137125702 | ||||||||
| FaxNumber: | 8133771005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9205170 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 008654200 | 05 | FL | MEDICAID | Y0C2J | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |