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General NPI Number Information
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NPI Number | 1851555924
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Entity Type | Individual
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Provider Name | JENNIFER ANN GIBLIN M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 1228 S DAYTONA AVE
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3715
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Country | US
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Telephone | 386-837-6383
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FLORIDA PARK DRIVE SUITE 315
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City | PALM COAST
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State | FL
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Zip | 32137
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Country | US
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Telephone | 386-837-6383
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8558
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License Number State | FL
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