Healthcare Provider Details

I. General information

NPI: 1396658688
Provider Name (Legal Business Name): MARIE ALENE WEAVER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12147 SE 55TH ST
OKEECHOBEE FL
34974-1936
US

IV. Provider business mailing address

12147 SE 55TH ST
OKEECHOBEE FL
34974-1936
US

V. Phone/Fax

Practice location:
  • Phone: 561-707-7702
  • Fax:
Mailing address:
  • Phone: 561-707-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN9168566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: