Provider Demographics
NPI:1245486034
Name:SMITH, JESSICA LEIGH GLEATON (AP, DOM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH GLEATON
Last Name:SMITH
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 KEVIN DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2780
Mailing Address - Country:US
Mailing Address - Phone:941-726-5746
Mailing Address - Fax:
Practice Address - Street 1:520 KEVIN DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2780
Practice Address - Country:US
Practice Address - Phone:941-726-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2543171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist