Provider Demographics
NPI:1023000254
Name:MAGNUS, JACINTA C (MD)
Entity Type:Individual
Prefix:MS
First Name:JACINTA
Middle Name:C
Last Name:MAGNUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 SHERIDAN ST.
Mailing Address - Street 2:SUITE #270
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3422
Mailing Address - Country:US
Mailing Address - Phone:954-989-6000
Mailing Address - Fax:954-378-4775
Practice Address - Street 1:4651 SHERIDAN ST.
Practice Address - Street 2:SUITE #270
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3422
Practice Address - Country:US
Practice Address - Phone:954-989-6000
Practice Address - Fax:954-378-4775
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048649300Medicaid
FL048649300Medicaid
FL05838Medicare ID - Type Unspecified