Provider Demographics
NPI:1205833266
Name:JOSEPH, JENNIE SUSAN (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:SUSAN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S DILLARD ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3596
Mailing Address - Country:US
Mailing Address - Phone:407-656-6938
Mailing Address - Fax:407-656-9161
Practice Address - Street 1:213 S. DILLARD ST
Practice Address - Street 2:SUITE 340
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2922
Practice Address - Country:US
Practice Address - Phone:407-656-6938
Practice Address - Fax:407-656-9161
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 374J00000X
FLMW0053176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No172V00000XOther Service ProvidersCommunity Health Worker
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340010700Medicaid