Provider Demographics
NPI:1205033602
Name:WHITE, JENNIFER M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-8900
Mailing Address - Fax:813-974-2478
Practice Address - Street 1:3515 E FLETCHER AVE
Practice Address - Street 2:MDC90
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4702
Practice Address - Country:US
Practice Address - Phone:813-974-8900
Practice Address - Fax:813-974-2478
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1102812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003961500Medicaid
FL14F6ROtherBLUE CROSS BLUE SHIELD
FL003961500Medicaid