Provider Demographics
NPI:1619968617
Name:THIELHELM, JENNIFER S (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:THIELHELM
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 1:800 N MAITLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4499
Mailing Address - Country:US
Mailing Address - Phone:407-660-7000
Mailing Address - Fax:407-660-7106
Practice Address - Street 1:800 N MAITLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4499
Practice Address - Country:US
Practice Address - Phone:407-660-7000
Practice Address - Fax:407-660-7106
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64039208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375714500Medicaid
F66325Medicare UPIN