Provider Demographics
NPI:1194242933
Name:LEONARD, THOMAS J (RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:LEONARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 GROSVENOR CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6118
Mailing Address - Country:US
Mailing Address - Phone:916-849-4745
Mailing Address - Fax:
Practice Address - Street 1:2890 GATEWAY OAKS DR STE 250
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-4328
Practice Address - Country:US
Practice Address - Phone:916-649-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277261163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management