=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164189015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIE LECLAIR SPENCER ARNP,FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2021
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 N RIDGEWOOD DR
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-7217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-658-2611
-----------------------------------------------------
Fax | 863-658-2517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 N RIDGEWOOD DR
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-7217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-304-8614
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 11016772
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 11016772
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------