Provider Demographics
NPI:1942866611
Name:SIPLIN-KERRIN, LINDA R
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:R
Last Name:SIPLIN-KERRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11855 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8878
Mailing Address - Country:US
Mailing Address - Phone:904-616-2727
Mailing Address - Fax:904-503-7465
Practice Address - Street 1:11855 ALEXANDRA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8878
Practice Address - Country:US
Practice Address - Phone:904-616-2727
Practice Address - Fax:904-503-7465
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities