Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 11003695 | FL |
NPI | 1003464074 |
---|---|
Provider Name | Leslie Kapp-Jones |
First Address | Tampa, FL 33682-2969 |
Second Address | Tampa, FL 33613-4613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2019 |
Last Update Date | 06/04/2020 |