Provider Demographics
NPI:1447796149
Name:LEIGHTON, JACQUELYNNE ANNE (PNP)
Entity type:Individual
Prefix:
First Name:JACQUELYNNE
Middle Name:ANNE
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ARLINGTON ST
Mailing Address - Street 2:APT 1
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1313
Mailing Address - Country:US
Mailing Address - Phone:781-254-1971
Mailing Address - Fax:
Practice Address - Street 1:320 BOLTON ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3988
Practice Address - Country:US
Practice Address - Phone:508-460-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303107363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics