Provider Demographics
NPI:1477018836
Name:JENEMA, JENNNIFER ELIZABETH
Entity Type:Individual
Prefix:
First Name:JENNNIFER
Middle Name:ELIZABETH
Last Name:JENEMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7407
Mailing Address - Country:US
Mailing Address - Phone:727-776-3212
Mailing Address - Fax:
Practice Address - Street 1:4001 4TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7407
Practice Address - Country:US
Practice Address - Phone:727-776-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst