Provider Demographics
NPI:1104344134
Name:LIBBY, BREANNA LEA (FNP-BC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEA
Last Name:LIBBY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JONESPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04649-3345
Mailing Address - Country:US
Mailing Address - Phone:207-598-9648
Mailing Address - Fax:
Practice Address - Street 1:5 LIBBY LANE
Practice Address - Street 2:
Practice Address - City:BEALS
Practice Address - State:ME
Practice Address - Zip Code:04611
Practice Address - Country:US
Practice Address - Phone:207-598-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP171113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily