Provider Demographics
NPI:1346299302
Name:BRANCONI, JEANIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:M
Last Name:BRANCONI
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 1:6533 SANTIAGO CT
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2111
Mailing Address - Country:US
Mailing Address - Phone:813-843-0428
Mailing Address - Fax:
Practice Address - Street 1:6533 SANTIAGO CT
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2111
Practice Address - Country:US
Practice Address - Phone:813-843-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70858207Q00000X
FLME 70858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty