Provider Demographics
NPI:1760286991
Name:WOODLAND, LEAVITT (PA-C)
Entity type:Individual
Prefix:MR
First Name:LEAVITT
Middle Name:
Last Name:WOODLAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 E 12300 N
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:UT
Mailing Address - Zip Code:84320-2140
Mailing Address - Country:US
Mailing Address - Phone:805-801-5751
Mailing Address - Fax:
Practice Address - Street 1:1099 E 12300 N
Practice Address - Street 2:
Practice Address - City:COVE
Practice Address - State:UT
Practice Address - Zip Code:84320-2140
Practice Address - Country:US
Practice Address - Phone:805-801-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant