Provider Demographics
NPI:1467964288
Name:LEBLANC, JESSICA (FNP - C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:FNP - C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:POLANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:139 DORSET RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-3250
Mailing Address - Country:US
Mailing Address - Phone:978-857-5811
Mailing Address - Fax:
Practice Address - Street 1:242 GREEN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1336
Practice Address - Country:US
Practice Address - Phone:978-669-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily