Provider Demographics
NPI:1538191903
Name:LEONARD, LYNN ANN (AA)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ANN
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-0077
Mailing Address - Fax:352-265-6922
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0077
Practice Address - Fax:352-265-6922
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101782363A00000X
FLAA160367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009471000Medicaid
FL009471000Medicaid
FLE7521VMedicare PIN
FLE7521XMedicare PIN
FLE7521WMedicare PIN