Healthcare Provider Details

I. General information

NPI: 1356202535
Provider Name (Legal Business Name): LEANNA CONVERTINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N PARROTT AVE
OKEECHOBEE FL
34972-2645
US

IV. Provider business mailing address

668 SW 86TH TER
OKEECHOBEE FL
34974-1534
US

V. Phone/Fax

Practice location:
  • Phone: 863-824-3480
  • Fax:
Mailing address:
  • Phone: 863-824-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11043778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: