Provider Demographics
NPI:1770047987
Name:WHITE, LEAH ANN (APRN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:ANN
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3940 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2702
Mailing Address - Country:US
Mailing Address - Phone:352-359-7803
Mailing Address - Fax:
Practice Address - Street 1:919 NW 57TH ST STE 10
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6437
Practice Address - Country:US
Practice Address - Phone:352-474-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily