Individual provider Active NPI

Susan Marie Leskanic, APRN

  • Primary Care Nurse Practitioner
  • Lake Mary, FL
National Provider Identifier
1376891473
Registry record updated Apr 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
ARNP9227765 Issued in FL
Practice address
138 W. Crystal Lake Ave. Ste #1100
Lake Mary, FL 32746
Phone
(407) 915-6570
Fax
(407) 915-6572
NPI assigned
Aug 21, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X ARNP9227765 FL Primary

Addresses

Primary practice location

138 W. Crystal Lake Ave. Ste #1100
Lake Mary, FL 32746

Mailing address

138 W. Crystal Lake Ave. Ste #1100
Lake Mary, FL 32746
Phone (407) 915-6570

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
I20130730000201 FL Order and Referring Only - Nurse Practitioner 5395986699

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1376891473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 W. CRYSTAL LAKE AVE. STE #1100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "32746",
            "telephone_number": "407-915-6570",
            "fax_number": "407-915-6572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 W. CRYSTAL LAKE AVE. STE #1100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "32746",
            "telephone_number": "407-915-6570",
            "fax_number": "407-915-6572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESKANIC",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-21",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "FL",
            "license": "ARNP9227765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.