Provider Demographics
NPI:1679349492
Name:HAYNES, LEONARD ANTHONY (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:ANTHONY
Last Name:HAYNES
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:MR
Other - First Name:LEONARD
Other - Middle Name:
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5030 BRUNSON DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2412
Mailing Address - Country:US
Mailing Address - Phone:347-932-7249
Mailing Address - Fax:
Practice Address - Street 1:5030 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2412
Practice Address - Country:US
Practice Address - Phone:347-932-7249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129001163W00000X, 367500000X
FLRN9538531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse