Doctor Name: | EVAN JAMES LEONARD |
NPI Number: | 1558765875 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A.-C |
License Number: | PA9108342 |
Business Practice Address: | 851042 Us Highway 17 Yulee, FL - 320972845 |
Business Phone Number: | 9046330670 |
Business Fax Number: | |
Mailing Address: | 653 Monument Rd, Apartment 1512 JACKSONVILLE |
State: | FL |
Postal Code: | 322256492 |
Phone Number: | 7272537041 |
Fax Number: | |
NPI Enumeration Date: | 10/15/2014 |
NPI Last Update Date: | 04/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9108342 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |