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General NPI Number Information
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NPI Number | 1740836329
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Entity Type | Individual
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Provider Name | JILANN B DOUCETTE RD, LDN
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Gender | Female
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Dates
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Enumeration Date | 08/10/2019
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Last Update Date | 08/10/2019
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Provider Practice Location Address
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Address Line | 1 FARRADAY LN UNIT F
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City | PALM COAST
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State | FL
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Zip | 32137-3853
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Country | US
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Telephone | 386-523-6672
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CEDARFIELD CT
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City | PALM COAST
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State | FL
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Zip | 32137-8950
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Country | US
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Telephone | 386-523-6672
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7404
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 7404
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 7404
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 7404
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License Number State | FL
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