Provider Demographics
NPI:1508155904
Name:MICHAEL, JENNY E (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:E
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:SIUTE 200
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-767-6060
Mailing Address - Fax:727-767-1285
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:SIUTE 200
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-767-6060
Practice Address - Fax:727-767-1285
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN57345207V00000X
FLME119384207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology