Provider Demographics
NPI:1376834564
Name:CARRERAS-MONTGOMERY, JENNEL MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JENNEL
Middle Name:MARIE
Last Name:CARRERAS-MONTGOMERY
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 1:3320 SW 34TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3371
Mailing Address - Country:US
Mailing Address - Phone:352-629-8154
Mailing Address - Fax:352-629-5231
Practice Address - Street 1:3320 SW 34TH CIR
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3371
Practice Address - Country:US
Practice Address - Phone:352-629-8154
Practice Address - Fax:352-629-5231
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME135316208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty