Provider Demographics
NPI:1568207066
Name:LEONE, KIM (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:LEONE
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 TOMLINSON TER
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6309
Mailing Address - Country:US
Mailing Address - Phone:407-902-4215
Mailing Address - Fax:
Practice Address - Street 1:498 PALM SPRINGS DR STE 100
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7849
Practice Address - Country:US
Practice Address - Phone:407-902-4215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL240143376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker