1356645972 NPI number — LEIGH ANN TESAR ARNP

Table of content: LEIGH ANN TESAR ARNP (NPI 1356645972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356645972 NPI number — LEIGH ANN TESAR ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TESAR
Provider First Name:
LEIGH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OSBORN
Provider Other First Name:
LEIGH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356645972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2019
NPI Reactivation Date:
04/11/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6643 38TH LN E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34243-7962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8614 STATE ROAD 70 E STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34202-3710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-216-3800
Provider Business Practice Location Address Fax Number:
941-216-3703
Provider Enumeration Date:
12/23/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN9217888 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN9217888 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003821700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".