Provider Demographics
NPI:1376049460
Name:KACZMAREK, JESSICA VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:VICTORIA
Last Name:KACZMAREK
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 1:2135 ACKLEN AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-3523
Mailing Address - Country:US
Mailing Address - Phone:803-335-6749
Mailing Address - Fax:
Practice Address - Street 1:2215 GARLAND AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0019
Practice Address - Country:US
Practice Address - Phone:803-335-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program