Provider Demographics
NPI:1972045003
Name:BUCKLER, JESSICA (CLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BUCKLER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13241 BARTRAM PARK BLVD UNIT 217
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5233
Mailing Address - Country:US
Mailing Address - Phone:904-723-4078
Mailing Address - Fax:904-674-2313
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 217
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5233
Practice Address - Country:US
Practice Address - Phone:904-723-4078
Practice Address - Fax:904-674-2313
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN