Provider Demographics
NPI:1871115360
Name:MINELGA, LEONIDA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LEONIDA
Middle Name:
Last Name:MINELGA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S WILD ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8378
Mailing Address - Country:US
Mailing Address - Phone:386-316-8212
Mailing Address - Fax:866-797-0579
Practice Address - Street 1:320 S WILD ORANGE DR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8378
Practice Address - Country:US
Practice Address - Phone:386-316-8212
Practice Address - Fax:866-797-0579
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2627342163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management