Provider Demographics
NPI:1407415540
Name:JEAN-LEON, CHRISTINE (RN, ADMN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:JEAN-LEON
Suffix:
Gender:F
Credentials:RN, ADMN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 OAKFIELD DR STE. 115A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4930
Mailing Address - Country:US
Mailing Address - Phone:813-774-3201
Mailing Address - Fax:813-774-3202
Practice Address - Street 1:1111 OAKFIELD DR STE. 115A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4930
Practice Address - Country:US
Practice Address - Phone:813-774-3201
Practice Address - Fax:813-774-3202
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9305114163W00000X
FL374U00000X
FL299994813251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101236100Medicaid