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General NPI Number Information
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NPI Number | 1578926341
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Entity Type | Individual
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Provider Name | JILLIAN LEBLANC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 333 1ST ST N
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-6945
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Country | US
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Telephone | 866-581-5038
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Fax |
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Provider Business Mailing Address
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Address Line | 605 JOHNSTON ST
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-2123
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Country | US
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Telephone | 906-259-3191
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | L1-0048342
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License Number State | DE
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