Provider Demographics
NPI:1982705018
Name:LEATHEM, JANET R (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:R
Last Name:LEATHEM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5749 CAMINO DEL SOL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6564
Mailing Address - Country:US
Mailing Address - Phone:954-800-0234
Mailing Address - Fax:
Practice Address - Street 1:5749 CAMINO DEL SOL
Practice Address - Street 2:SUITE 206
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6564
Practice Address - Country:US
Practice Address - Phone:954-800-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9313958363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health