Provider Demographics
NPI:1518178870
Name:GARCIA, JACKLYN ELAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:ELAINE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-1128
Mailing Address - Country:US
Mailing Address - Phone:419-943-3639
Mailing Address - Fax:
Practice Address - Street 1:48 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-1128
Practice Address - Country:US
Practice Address - Phone:419-943-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-110467164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse