Individual
LEAH JEAN THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
819 HARBOR IS, CLEARWATER, FL 33767-1807
(772) 708-4310
Mailing address
600 115TH AVE, TREASURE ISLAND, FL 33706-3050
(772) 708-4310
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN579293
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9307894
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002866300
—
FL
01
—
DH280W
TAMPA
FL
01
—
G00KR
BCBS OF FL
FL
Enumeration date
07/29/2009
Last updated
02/08/2024
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