Individual
JIMMEQUIA LANICE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C
Contact information
Practice address
117 JAMES ST, WOODBINE, GA 31569-3568
(912) 576-1967
Mailing address
PO BOX 992, WOODBINE, GA 31569-0992
(912) 674-9370
Taxonomy
Speciality
Code
Description
License number
State
163WH1000X
Hospice Registered Nurse
RN271383
GA
163WM0705X
Medical-Surgical Registered Nurse
RN271383
GA
363LF0000X
Family Nurse Practitioner
Primary
RN271383
GA
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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