Provider Demographics
NPI:1659643310
Name:SEIBERT, JADE LEE-ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:LEE-ANN
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 PAULA DR S
Mailing Address - Street 2:APT. B
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2066
Mailing Address - Country:US
Mailing Address - Phone:727-324-7663
Mailing Address - Fax:
Practice Address - Street 1:25022 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-3918
Practice Address - Country:US
Practice Address - Phone:727-216-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56490163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)