Provider Demographics
NPI:1720807977
Name:LEIDY, PATRICIA (FNP-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LEIDY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 SOUTH DUPONT HIGHWAY
Mailing Address - Street 2:ST 2
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:302-698-1100
Mailing Address - Fax:
Practice Address - Street 1:4601 SOUTH DUPONT HIGHWAY
Practice Address - Street 2:ST 2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-698-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-05
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012961363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner