| Doctor Name: | MR. JASON CARLO LIBBY |
| NPI Number: | 1083724231 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.P. |
| License Number: | 13528 |
| Business Practice Address: | 100 U.s. Route 1 Scarborough, ME - 04074 |
| Business Phone Number: | 2072833640 |
| Business Fax Number: | 2078831506 |
| Mailing Address: | 100 U.s. Route 1, SCARBOROUGH |
| State: | ME |
| Postal Code: | 04074 |
| Phone Number: | 2072833640 |
| Fax Number: | 2078831506 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 10/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 13528 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |