Leiane Moore Boudreau, ARNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

ARNP2514302 Issued in FL

Practice address

1301 Plantation Island Dr S
Suite 106a
Saint Augustine, FL 32080-3108

Phone

(904) 460-9191

Fax

(904) 471-4859

NPI assigned

Feb 29, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Leiane C Moore Professional name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650

  Nurse Practitioner

  Medicare reassignment NPD

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420416000000",
    "number": "1588833958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "SUITE 106A",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-460-9191",
            "fax_number": "904-471-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "SUITE 106A",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-460-9191",
            "fax_number": "904-471-4859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "LEIANE",
        "middle_name": "MOORE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-29",
        "last_updated": "2015-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP2514302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEIANE",
            "last_name": "MOORE",
            "middle_name": "C",
            "credential": "ARNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Claudia Borrero
• David M Bortnick, PHD PSYD ABN
• Jack Bosma, PT, DPT, CSCS
• Cody Bryan Boswell, DC
• Hugo Botero, DPT
• Luis J Boulier, COTA
• Soufyane Bourass
• Richard Bourdon Escoda, PSY.D.
• Terri Bowling, OT
• Justin Scott Bowman, FNP-BC

• Nurse Practitioner in Saint Augustine, FL
• Providers in Saint Augustine, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.