Provider Demographics
NPI:1578891149
Name:BOND, JENNIFER
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:BOND
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 1:4014 GUNN HWY
Mailing Address - Street 2:SUITE 95
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8787
Mailing Address - Country:US
Mailing Address - Phone:813-443-4619
Mailing Address - Fax:
Practice Address - Street 1:4014 GUNN HWY
Practice Address - Street 2:SUITE 95
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8787
Practice Address - Country:US
Practice Address - Phone:813-443-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7650103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist