Provider Demographics
NPI:1104638139
Name:ASBERRY, LEANDREA ROSE
Entity type:Individual
Prefix:
First Name:LEANDREA
Middle Name:ROSE
Last Name:ASBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 CONCORD BLVD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2862
Mailing Address - Country:US
Mailing Address - Phone:904-884-3113
Mailing Address - Fax:
Practice Address - Street 1:8490 CONCORD BLVD E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2862
Practice Address - Country:US
Practice Address - Phone:904-884-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 251E00000X
FLCNA417568374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115413500Medicaid