Provider Demographics
NPI:1376712604
Name:VISIONARY GYNECOLOGY PL
Entity Type:Organization
Organization Name:VISIONARY GYNECOLOGY PL
Other - Org Name:VISIONARY COSMETIC GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-540-0414
Mailing Address - Street 1:2840 W BAY DR
Mailing Address - Street 2:#128
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2620
Mailing Address - Country:US
Mailing Address - Phone:727-540-0414
Mailing Address - Fax:727-540-0672
Practice Address - Street 1:2695 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3335
Practice Address - Country:US
Practice Address - Phone:727-540-0414
Practice Address - Fax:727-540-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5756207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN