Provider Demographics
NPI:1679372155
Name:MOONEY, LESIA H (APRN)
Entity type:Individual
Prefix:
First Name:LESIA
Middle Name:H
Last Name:MOONEY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:LESIA
Other - Middle Name:HOPE
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, RN
Mailing Address - Street 1:11848 LORETTO SQUARE DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-4045
Mailing Address - Country:US
Mailing Address - Phone:904-504-0582
Mailing Address - Fax:904-504-0583
Practice Address - Street 1:11848 LORETTO SQUARE DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-4045
Practice Address - Country:US
Practice Address - Phone:904-504-0582
Practice Address - Fax:904-504-0583
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9176690364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health