Provider Demographics
NPI:1710975388
Name:JEANNERET, LETICIA B (ARNP)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:B
Last Name:JEANNERET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4620 N STATE ROAD 7
Mailing Address - Street 2:STE 316
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5884
Mailing Address - Country:US
Mailing Address - Phone:954-967-6400
Mailing Address - Fax:954-967-6410
Practice Address - Street 1:3126 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6738
Practice Address - Country:US
Practice Address - Phone:954-941-3255
Practice Address - Fax:954-941-7797
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3262702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics