Provider Demographics
NPI:1427243039
Name:CARRASQUILLO, LEAH (FNP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PARC PLACE
Mailing Address - Street 2:NASHAWANNUCK INTERNAL MEDICINE
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073
Mailing Address - Country:US
Mailing Address - Phone:413-529-9282
Mailing Address - Fax:413-527-7526
Practice Address - Street 1:6 PARC PL
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9277
Practice Address - Country:US
Practice Address - Phone:413-529-9282
Practice Address - Fax:413-527-7526
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily