Individual
MS. JEAN THIBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP, MPH
Contact information
Practice address
4525 CAMERON VALLEY PARKWAY, CHARLOTTE, NC 28211-3546
(704) 302-8310
Mailing address
2995 DREW STREET, EAST BLDG 2ND FLOOR, CLEARWATER, FL 33759
(727) 281-9390
(813) 635-2613
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1-104989
AL
363LF0000X
Family Nurse Practitioner
Primary
5004969
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7004773
—
NC
Enumeration date
01/18/2010
Last updated
01/31/2019
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