Provider Demographics
NPI:1457327413
Name:JAMESON, JENNIFER ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:JAMESON
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 1:4980 TAMIAMI TRL N STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2849
Mailing Address - Country:US
Mailing Address - Phone:239-649-2300
Mailing Address - Fax:
Practice Address - Street 1:4980 TAMIAMI TRL N STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2849
Practice Address - Country:US
Practice Address - Phone:239-649-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-02454207Q00000X
WV26808207Q00000X
IL036139700207Q00000X
FLME127058207Q00000X, 207QA0401X
SC39124207Q00000X
MN60243207Q00000X
OH35.128045207Q00000X
KY49232207Q00000X
TN53757207Q00000X
CA142950207Q00000X
GA075541207Q00000X
VA0101261165207Q00000X
NH12494207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204676Medicaid
NHRE7974Medicare ID - Type Unspecified
H69267Medicare UPIN