Provider Demographics
NPI:1114155678
Name:ADAMS, JENNY WAWRZYNIAK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:WAWRZYNIAK
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3435 PINE RIDGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3828
Mailing Address - Country:US
Mailing Address - Phone:239-260-7476
Mailing Address - Fax:239-260-7608
Practice Address - Street 1:3435 PINE RIDGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3828
Practice Address - Country:US
Practice Address - Phone:239-300-9703
Practice Address - Fax:239-206-8263
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR161213ES0103X
FLPO3507213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008828100Medicaid
FLGY853AMedicare PIN