Provider Demographics
NPI:1962425546
Name:ROSENBERG, LESLIE DAWN (APRN)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:DAWN
Last Name:ROSENBERG
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHILD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-0001
Mailing Address - Country:US
Mailing Address - Phone:904-270-4280
Mailing Address - Fax:904-270-4456
Practice Address - Street 1:2104 MASSEY AVE.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4280
Practice Address - Fax:904-270-4456
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3004482363LP0808X
FL3004480363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764133801Medicaid
FLU1055YMedicare ID - Type Unspecified
FL764133801Medicaid
FLP00987780Medicare PIN