Provider Demographics
NPI:1336774520
Name:OTTO, LEAH (DNP, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:OTTO
Suffix:
Gender:
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:SEIM-BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8300 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-9960
Mailing Address - Fax:210-450-2139
Practice Address - Street 1:8300 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9960
Practice Address - Fax:210-450-2139
Is Sole Proprietor?:No
Enumeration Date:2020-03-08
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60225746163W00000X
TX1020730363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology