Provider Demographics
NPI:1447805924
Name:COUGHLIN, JENNA LYNN (RN,IBCLC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 SOUTHERN CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4520
Mailing Address - Country:US
Mailing Address - Phone:850-501-6983
Mailing Address - Fax:
Practice Address - Street 1:706 SOUTHERN CT
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4520
Practice Address - Country:US
Practice Address - Phone:850-501-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9207717163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty