Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW361 | FL |
NPI | 1053808592 |
---|---|
Provider Name | Kellyanne Saoirse Jaber |
First Address | Jacksonville, FL 32221-7638 |
Second Address | Jacksonville, FL 32210-4868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 19/04/2018 |