Provider Demographics
NPI:1538106604
Name:FYNN, JENNIFER EFUA AMOA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:EFUA AMOA
Last Name:FYNN
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 1:2501 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-303-2528
Mailing Address - Fax:
Practice Address - Street 1:101 AVENUE O SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4333
Practice Address - Country:US
Practice Address - Phone:863-294-7039
Practice Address - Fax:863-291-5963
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAC15532372080N0001X
FLME919202080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271289000Medicaid