Provider Demographics
NPI:1629038880
Name:FERNANDES, JACQUELINE SOUZA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SOUZA
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:508 JEFFORDS ST STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3839
Practice Address - Country:US
Practice Address - Phone:727-413-5061
Practice Address - Fax:727-447-0314
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123990207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology