Provider Demographics
NPI:1922825983
Name:GINN, LEAH OLIVIA
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:OLIVIA
Last Name:GINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NW FLAGLER AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-1163
Mailing Address - Country:US
Mailing Address - Phone:772-607-0079
Mailing Address - Fax:
Practice Address - Street 1:561 NW LAKE WHITNEY PL STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1624
Practice Address - Country:US
Practice Address - Phone:772-607-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034956363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health