Provider Demographics
NPI:1609071372
Name:GOTTLIEB, JEANNE CHATHAM (ARNP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:CHATHAM
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 SW 148TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7848
Mailing Address - Country:US
Mailing Address - Phone:305-253-5209
Mailing Address - Fax:
Practice Address - Street 1:9333 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1778
Practice Address - Country:US
Practice Address - Phone:305-256-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1451552363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology