Healthcare Provider Details

I. General information

NPI: 1659844306
Provider Name (Legal Business Name): LEEANNE ODUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 NW 56TH TER STE B
GAINESVILLE FL
32605-6401
US

IV. Provider business mailing address

817 NW 56TH TER STE B
GAINESVILLE FL
32605-6401
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-3050
  • Fax:
Mailing address:
  • Phone: 352-234-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9360736
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: