Provider Demographics
NPI:1023372042
Name:CHAMBERS, JENNIFER REBECCA (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REBECCA
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 PARK ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1044
Mailing Address - Country:US
Mailing Address - Phone:727-547-8425
Mailing Address - Fax:813-635-2699
Practice Address - Street 1:5405 PARK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1044
Practice Address - Country:US
Practice Address - Phone:727-547-8425
Practice Address - Fax:813-635-2699
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3110207Q00000X
FLOS12324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIG187ZOtherMEDICARE
FL014813800Medicaid