Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN204055 | GA |
NPI | 1003372293 |
---|---|
Provider Name | Tanisha Leonard |
First Address | Tucker, GA 30084-6901 |
Second Address | Marietta, GA 30066-5753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2019 |
Last Update Date | 26/08/2020 |