Provider Demographics
NPI:1639830961
Name:DOCHERTY, JAMIE ELLEN (IBCLC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ELLEN
Last Name:DOCHERTY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:DOCHERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:2416 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3529
Mailing Address - Country:US
Mailing Address - Phone:757-348-4972
Mailing Address - Fax:
Practice Address - Street 1:2416 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3529
Practice Address - Country:US
Practice Address - Phone:757-346-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-306112174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN