Provider Demographics
NPI:1457175929
Name:COLLAZO, LESLIE LEEANNE (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:LEEANNE
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7743 CHATHAM PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3873
Mailing Address - Country:US
Mailing Address - Phone:956-529-3815
Mailing Address - Fax:
Practice Address - Street 1:7743 CHATHAM PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3873
Practice Address - Country:US
Practice Address - Phone:956-529-3815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1179659363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health