Provider Demographics
NPI:1386635548
Name:BALL, JENNIFER L (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN: CREDENTIAL DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2029
Practice Address - Country:US
Practice Address - Phone:727-216-1141
Practice Address - Fax:727-796-6459
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6862207RH0000X
FLOS6861207RX0202X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261639400Medicaid
FL49870OtherBLUE CROSS / BLUE SHIELD
FL261639400Medicaid
FL49870OtherBLUE CROSS / BLUE SHIELD
FL498702YMedicare PIN
FLP00090341OtherMEDICARE RR
FL261639400Medicaid