Provider Demographics
NPI:1669563151
Name:TABOR, LEIGH ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:ANN
Last Name:TABOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:TABOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:6101 LAKE ELLENOR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4616
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-322-8725
Practice Address - Street 1:6101 LAKE ELLENOR DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4616
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-322-8725
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9180329363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01233921OtherAMERIGROUP
FL308690900Medicaid
FL479547OtherWELLCARE