Provider Demographics
NPI:1396140307
Name:SKIRVIN-LECLAIR, BRIAN (APRN, DNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SKIRVIN-LECLAIR
Suffix:
Gender:M
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:772-336-2818
Mailing Address - Fax:772-336-5313
Practice Address - Street 1:1850 SW FOUNTAINVIEW BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4527
Practice Address - Country:US
Practice Address - Phone:772-336-2818
Practice Address - Fax:772-336-5313
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9403698363LP0200X
MARN228508363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015354200Medicaid