Provider Demographics
NPI:1629419320
Name:STUART, JENNIFER PAIGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PAIGE
Last Name:STUART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:3201 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1510
Practice Address - Country:US
Practice Address - Phone:727-344-2355
Practice Address - Fax:727-344-7166
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14R4SOtherFLORIDA BLUE
FL3639072OtherUNITED
FLP01206855OtherRAILROAD MEDICARE
FL009359600Medicaid
FL4802431OtherAETNA
FL7480384OtherCIGNA HEALTHCARE
FLP01206855OtherRAILROAD MEDICARE