1730168568 NPI number — LEIGH NOGAH BITTNER APRN

Table of content: LEIGH NOGAH BITTNER APRN (NPI 1730168568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730168568 NPI number — LEIGH NOGAH BITTNER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOGAH BITTNER
Provider First Name:
LEIGH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOGAH
Provider Other First Name:
LEIGH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730168568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 NORTH HARRISON PARKWAY
Provider Second Line Business Mailing Address:
BLDG C-SUITE #200
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-838-2371
Provider Business Mailing Address Fax Number:
954-851-1746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 WESTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-689-5000
Provider Business Practice Location Address Fax Number:
954-659-6047
Provider Enumeration Date:
01/11/2006

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: 363L00000X , with the licence number:  ARNP16721751 , 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: ARNP1751672 , 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: 025154400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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