Provider Demographics
NPI:1437847571
Name:TOBIN, JACQUELINE (IBCLC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:TOBIN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MUNSTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-5036
Mailing Address - Country:US
Mailing Address - Phone:405-830-6984
Mailing Address - Fax:
Practice Address - Street 1:25 MUNSTER DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-5036
Practice Address - Country:US
Practice Address - Phone:405-830-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-116414174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN