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General NPI Number Information
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NPI Number | 1073388245
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Entity Type | Individual
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Provider Name | JENNA LEIGH THIBEAULT APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 600 CENTER ST
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City | AUBURN
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State | ME
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Zip | 04210-6311
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Country | US
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Telephone | 207-955-5565
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Fax | 207-955-5572
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Provider Business Mailing Address
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Address Line | 360 US HIGHWAY 1 BYP UNIT 102
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City | PORTSMOUTH
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State | NH
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Zip | 03801-7105
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Country | US
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Telephone | 603-410-6700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12346725-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP241179
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License Number State | ME
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