Provider Demographics
NPI:1326046335
Name:NESBITT, JACKI LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACKI
Middle Name:LYNN
Last Name:NESBITT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 MEMORIAL CIR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5002
Mailing Address - Country:US
Mailing Address - Phone:386-672-9250
Mailing Address - Fax:386-672-9251
Practice Address - Street 1:570 MEMORIAL CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5002
Practice Address - Country:US
Practice Address - Phone:386-672-9250
Practice Address - Fax:386-672-9251
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7098103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical