Healthcare Provider Details

I. General information

NPI: 1669087722
Provider Name (Legal Business Name): NORMA LETICIA GOODRICH AG08200038
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 NW 5TH AVE
OKEECHOBEE FL
34972-2568
US

IV. Provider business mailing address

19265 NW 252ND ST
OKEECHOBEE FL
34972-6966
US

V. Phone/Fax

Practice location:
  • Phone: 863-261-8354
  • Fax: 863-638-5637
Mailing address:
  • Phone: 863-610-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number11008988
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008988
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN1108988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: