Provider Demographics
NPI:1053671875
Name:STINNETT, JACQULYNN DIANE (LMT)
Entity Type:Individual
Prefix:
First Name:JACQULYNN
Middle Name:DIANE
Last Name:STINNETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JACQULYNN
Other - Middle Name:DIANE
Other - Last Name:HALLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2955 BEE RIDGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7113
Mailing Address - Country:US
Mailing Address - Phone:941-929-0190
Mailing Address - Fax:941-929-0061
Practice Address - Street 1:2955 BEE RIDGE RD
Practice Address - Street 2:STE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7113
Practice Address - Country:US
Practice Address - Phone:941-929-0190
Practice Address - Fax:941-929-0061
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-26
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0005110225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist