Provider Demographics
NPI:1578992285
Name:OWEN, JENNIFER MADELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MADELINE
Last Name:OWEN
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 1:6900 NW 9TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4251
Mailing Address - Country:US
Mailing Address - Phone:352-333-6680
Mailing Address - Fax:352-331-4006
Practice Address - Street 1:2500 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2636
Practice Address - Country:US
Practice Address - Phone:510-204-5514
Practice Address - Fax:510-204-5515
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA133751207Q00000X, 207RC0200X, 208M00000X, 207RC0200X
FLME153793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA133751OtherSTATE MEDICAL LICENSE