Provider Demographics
NPI:1194509174
Name:PONCE DE LEON ARENCIBIA, LESLIET N (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LESLIET
Middle Name:N
Last Name:PONCE DE LEON ARENCIBIA
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20535 SW 122ND AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5693
Mailing Address - Country:US
Mailing Address - Phone:786-343-2172
Mailing Address - Fax:
Practice Address - Street 1:20535 SW 122ND AVE APT 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5693
Practice Address - Country:US
Practice Address - Phone:786-343-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily