Provider Demographics
NPI:1174516256
Name:LETTS, JEANNIE CYNTHIA (MD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:CYNTHIA
Last Name:LETTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:C
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2720 US HIGHWAY 1 S
Mailing Address - Street 2:STE B
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6301
Mailing Address - Country:US
Mailing Address - Phone:904-827-0078
Mailing Address - Fax:904-827-0140
Practice Address - Street 1:278 VT ROUTE 149
Practice Address - Street 2:
Practice Address - City:WEST PAWLET
Practice Address - State:VT
Practice Address - Zip Code:05775-9798
Practice Address - Country:US
Practice Address - Phone:802-645-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32918OtherBCBS
FL253362600Medicaid
FL32918OtherBCBS
FL32918Medicare PIN