Healthcare Provider Details

I. General information

NPI: 1023308335
Provider Name (Legal Business Name): LEANDRA CATARINA URIBE WOOLNOUGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANDRA CATARINA URIBE M.D.

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5252
  • Fax:
Mailing address:
  • Phone: 352-294-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20531137
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License NumberME137504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: