Provider Demographics
NPI:1689459281
Name:ACKERMAN, LESLIE (NP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:TRADE
Mailing Address - State:TN
Mailing Address - Zip Code:37691-0132
Mailing Address - Country:US
Mailing Address - Phone:239-290-0526
Mailing Address - Fax:
Practice Address - Street 1:540 YAUGH STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640
Practice Address - Country:US
Practice Address - Phone:336-246-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019337363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology