Individual
JACQUELINE MARIA NIEBLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
14499 N DALE MABRY HWY, SUITE 180-S, TAMPA, FL 33618-2078
(813) 501-3710
(813) 513-9395
Mailing address
1375 INDIAN TRL N, SUITE 180-S, PALM HARBOR, FL 34683-2809
(727) 481-8075
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME66997
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19311
WELLCARE
FL
01
—
212684
AMERIGROUP
DE
01
—
2238087
AETNA
FL
01
—
255357
AVMED
FL
01
—
26241
BLUE CROSS AND BLUE SHIEL
FL
01
—
2840575003
CIGNA
FL
05
—
376077400
—
FL
Enumeration date
10/11/2005
Last updated
05/03/2017
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