Individual provider Active NPI

Leslie Elizabeth Chacko, NP

  • Nurse Practitioner
  • Hallandale Beach, FL
National Provider Identifier
1356128698
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11024267 Issued in FL
Practice address
1750 E Hallandale Beach Blvd
Hallandale Beach, FL 33009-4611
Phone
(954) 265-4325
NPI assigned
Sep 11, 2023
Last updated
Sep 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11024267 FL Primary

Addresses

Primary practice location

1750 E Hallandale Beach Blvd
Hallandale Beach, FL 33009-4611

Mailing address

4011 W Sailboat Dr
Hollywood, FL 33026-1037

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231220001262 FL Practitioner - Nurse Practitioner 0446600274 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Florida Atlantic University, College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

1750 E Hallandale Beach Blvd
Hallandale Beach, FL 33009-4611
Phone (954) 265-4325

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11024267FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Nov 15, 2023 Accepting new patients
South Broward Hospital District Current Accepting new patients
South Broward Hospital District CurrentSince Nov 15, 2023 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

20950 NE 27th Ct
Ste 203
Aventura, FL 33180
Phone (305) 933-6545

1750 E Hallandale Beach Blvd
Hallandale Beach, FL 33009
Phone (954) 276-9700

1150 N 35th Ave
Ste 170
Hollywood, FL 33021
Phone (954) 985-1500

1150 N 35th Ave
Ste 330
Hollywood, FL 33021
Phone (954) 961-1500

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1356128698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 W SAILBOAT DR",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330261037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E HALLANDALE BEACH BLVD",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094611",
            "telephone_number": "954-265-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "LESLIE",
        "middle_name": "ELIZABETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-11",
        "last_updated": "2023-09-11",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11024267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hallandale Beach, FL

Sources for this page

Verify at the official NPI Registry.