Healthcare Provider Details

I. General information

NPI: 1497343503
Provider Name (Legal Business Name): JAIMMIE WENDOLYNE SIBREY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 SE 12TH TER
GAINESVILLE FL
32641-8104
US

IV. Provider business mailing address

842 SE 12TH TER
GAINESVILLE FL
32641-8104
US

V. Phone/Fax

Practice location:
  • Phone: 352-871-8904
  • Fax:
Mailing address:
  • Phone: 352-871-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT25778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: