Provider Demographics
NPI:1851515951
Name:BERNARD PANTIN, LESLEY ANN JOANNA (MBBS)
Entity type:Individual
Prefix:DR
First Name:LESLEY ANN
Middle Name:JOANNA
Last Name:BERNARD PANTIN
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:LESLEY ANN
Other - Middle Name:JOANNA
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:5200 NW 43RD STREET
Mailing Address - Street 2:SUITE 102-334
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 O'BRIEN DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0536782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81809OtherBLUE CROSS BLUE SHIELD
FL81809OtherBLUE CROSS BLUE SHIELD