Provider Demographics
NPI:1417835901
Name:CREGO LEON, LETICIA (APRN)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CREGO LEON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3845
Mailing Address - Country:US
Mailing Address - Phone:305-910-8710
Mailing Address - Fax:
Practice Address - Street 1:4250 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3845
Practice Address - Country:US
Practice Address - Phone:305-910-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL682507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine