Provider Demographics
NPI:1285401299
Name:LEUSCHNER, GUY RUSSELL (APRN)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:RUSSELL
Last Name:LEUSCHNER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PRESERVE CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7244
Mailing Address - Country:US
Mailing Address - Phone:717-304-5375
Mailing Address - Fax:
Practice Address - Street 1:116 PRESERVE CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-7244
Practice Address - Country:US
Practice Address - Phone:717-304-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily