Provider Demographics
NPI:1649204975
Name:CARIS, JENNIFER LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNNE
Last Name:CARIS
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 1:615 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4005
Mailing Address - Country:US
Mailing Address - Phone:831-425-7991
Mailing Address - Fax:831-425-7346
Practice Address - Street 1:615 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4005
Practice Address - Country:US
Practice Address - Phone:831-425-7991
Practice Address - Fax:831-425-7346
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55549207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84145895001OtherPACIFICARE
P00331233OtherRAILROAD MEDICARE
2370237OtherAETNA
CO82420033Medicaid
CO82420033Medicaid
COC805982Medicare PIN
CO84145895001OtherPACIFICARE