Provider Demographics
NPI:1912135963
Name:JOHNSTON, LESLIE ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 W SWANN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4038
Mailing Address - Country:US
Mailing Address - Phone:813-875-0555
Mailing Address - Fax:866-313-3106
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-875-0555
Practice Address - Fax:866-313-3106
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3548213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5276OtherMCARE GROUP PTAN
FLPO3548OtherMEDICAL LICENSE
FLDA5546OtherRR MCARE GROUP
FL6501WOtherBCBS
FLP01125212OtherRR MCARE IND
FLK5276OtherMCARE GROUP PTAN