Provider Demographics
NPI:1073222873
Name:LECKIE, ANTHOLETH JANICE (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANTHOLETH
Middle Name:JANICE
Last Name:LECKIE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:ANTHOLETH
Other - Middle Name:JANICE
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:326 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5734
Mailing Address - Country:US
Mailing Address - Phone:407-841-1100
Mailing Address - Fax:
Practice Address - Street 1:1115 E RIDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5443
Practice Address - Country:US
Practice Address - Phone:407-841-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023014363LG0600X
FL11023014363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117056000Medicaid