Provider Demographics
NPI:1003979006
Name:FIGUEROA-GORDIAN, JEANNETTE MARIE (MD)
Entity Type:Individual
Prefix:MISS
First Name:JEANNETTE
Middle Name:MARIE
Last Name:FIGUEROA-GORDIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:4700 N HABANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7116
Practice Address - Country:US
Practice Address - Phone:813-444-9599
Practice Address - Fax:813-513-8210
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14424208D00000X
FLACN480208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN480OtherMEDICAL LICENCE
PR14424OtherLICENSE