Provider Demographics
NPI:1154948693
Name:LEISHMAN, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LEISHMAN
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 1:228 BELL BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5413
Mailing Address - Country:US
Mailing Address - Phone:904-662-6886
Mailing Address - Fax:
Practice Address - Street 1:228 BELL BRANCH LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-5413
Practice Address - Country:US
Practice Address - Phone:904-662-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA341118174400000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174400000XOther Service ProvidersSpecialist