Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 11006201 | FL |
NPI | 1134752348 |
---|---|
Provider Name | Jennifer Moore Lemieux |
First Address | St Augustine, FL 32092-3222 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2020 |
Last Update Date | 17/02/2020 |