Provider Demographics
NPI:1225045552
Name:LEACH, DANA D (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:D
Last Name:LEACH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:DAWN JOHNSON
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-846-2114
Mailing Address - Fax:352-846-1904
Practice Address - Street 1:1600 SW ARCHER ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-846-2114
Practice Address - Fax:352-846-1904
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2519032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306434400Medicaid
FL306434400Medicaid