Healthcare Provider Details

I. General information

NPI: 1598412090
Provider Name (Legal Business Name): LEANNA WIEST LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 SAN PABLO RD S APT 211
JACKSONVILLE FL
32224-6806
US

IV. Provider business mailing address

3875 SAN PABLO RD S APT 211
JACKSONVILLE FL
32224-6806
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: