Healthcare Provider Details

I. General information

NPI: 1174366470
Provider Name (Legal Business Name): LETICIA CHRISTIE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SYBELIA AVE STE 150
MAITLAND FL
32751-4773
US

IV. Provider business mailing address

100 E SYBELIA AVE STE 150
MAITLAND FL
32751-4773
US

V. Phone/Fax

Practice location:
  • Phone: 407-986-7442
  • Fax: 407-790-7098
Mailing address:
  • Phone: 407-986-7442
  • Fax: 407-790-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11033316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: