Healthcare Provider Details

I. General information

NPI: 1164189015
Provider Name (Legal Business Name): JENNIE LECLAIR SPENCER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N RIDGEWOOD DR
SEBRING FL
33870-7217
US

IV. Provider business mailing address

810 N RIDGEWOOD DR
SEBRING FL
33870-7217
US

V. Phone/Fax

Practice location:
  • Phone: 863-658-2611
  • Fax: 863-658-2517
Mailing address:
  • Phone: 863-658-2611
  • Fax: 863-658-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11016772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: