Provider Demographics
NPI:1407021173
Name:SOSA, JACQUELINE Q (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:Q
Last Name:SOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:Q
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5950 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2532
Mailing Address - Country:US
Mailing Address - Phone:863-688-3550
Mailing Address - Fax:863-687-8969
Practice Address - Street 1:5950 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2532
Practice Address - Country:US
Practice Address - Phone:863-688-3550
Practice Address - Fax:863-687-8969
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-02593208000000X
FLME155925208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics