Provider Demographics
NPI:1871065920
Name:MUNCY, LEEANN DARDEN (PA)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:DARDEN
Last Name:MUNCY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 NW 13TH ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2342
Mailing Address - Country:US
Mailing Address - Phone:561-361-4075
Mailing Address - Fax:561-962-1555
Practice Address - Street 1:880 NW 13TH ST STE 2B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2342
Practice Address - Country:US
Practice Address - Phone:561-361-4075
Practice Address - Fax:561-962-1555
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant