Provider Demographics
NPI:1174734073
Name:ECHTERLING, JANE ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:ECHTERLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6414
Mailing Address - Country:US
Mailing Address - Phone:352-377-6084
Mailing Address - Fax:
Practice Address - Street 1:NORTHEAST FLORIDA STATE HOSPITAL
Practice Address - Street 2:7487 S. STATE ROAD 121
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063
Practice Address - Country:US
Practice Address - Phone:904-259-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical