Provider Demographics
NPI:1164189015
Name:SPENCER, JENNIE LECLAIR (ARNP,FNP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LECLAIR
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ARNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7217
Mailing Address - Country:US
Mailing Address - Phone:863-304-8614
Mailing Address - Fax:
Practice Address - Street 1:596 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2958
Practice Address - Country:US
Practice Address - Phone:863-314-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-25
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016772207RR0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty