Provider Demographics
NPI:1134016769
Name:PENNISI, LESLIE ANN (FNP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:PENNISI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 MILL CHASE LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6947
Mailing Address - Country:US
Mailing Address - Phone:704-641-3487
Mailing Address - Fax:
Practice Address - Street 1:14135 BALLANTYNE CORPORATE PL STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3870
Practice Address - Country:US
Practice Address - Phone:704-295-0777
Practice Address - Fax:704-295-0774
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022313363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner