Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME82566 | FL |
Y | 111NI0900X | Internist | ME82566 | FL |
N | 207RG0300X | Geriatric Medicine | ME82566 | FL |
NPI | 1114924339 |
---|---|
Provider Name | Nilsa Leiva |
First Address | Bradenton, FL 34210-3111 |
Second Address | Bradenton, FL 34210-3111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13634 | FL BCBS (01) | FL |
280623100 | (05) | FL |
H67798 | (02) | FL |