Provider Demographics
NPI:1497756944
Name:MCCULLEN, JENNIFER R (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MCCULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8340 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5180
Mailing Address - Country:US
Mailing Address - Phone:941-907-3008
Mailing Address - Fax:941-907-3036
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD
Practice Address - Street 2:STE 240
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5180
Practice Address - Country:US
Practice Address - Phone:941-907-3008
Practice Address - Fax:941-907-3036
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0066257207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376538500Medicaid
FL376538500Medicaid
25353AMedicare PIN