Provider Demographics
NPI:1639557069
Name:SIMPSON, JENNIFER NGUYEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NGUYEN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:DOMINIQUE
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8767 NW 20TH LANE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606
Mailing Address - Country:US
Mailing Address - Phone:714-548-7146
Mailing Address - Fax:
Practice Address - Street 1:1859 SW NEWLAND WAY
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6966
Practice Address - Country:US
Practice Address - Phone:386-758-0003
Practice Address - Fax:386-755-7940
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME132268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty