Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 7404 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | 7404 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | 7404 | FL |
NPI | 1740836329 |
---|---|
Provider Name | Mrs. Jilann B Doucette |
First Address | Palm Coast, FL 32137-8950 |
Second Address | Palm Coast, FL 32137-3853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2019 |
Last Update Date | 10/08/2019 |