Provider Demographics
NPI:1427872464
Name:ALLEN, JENNIE (LMT)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 PRINGLE CIR APT D
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-4413
Mailing Address - Country:US
Mailing Address - Phone:719-232-5610
Mailing Address - Fax:
Practice Address - Street 1:2219 COUNTY ROAD 220 STE 304
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-7778
Practice Address - Country:US
Practice Address - Phone:904-644-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist