Provider Demographics
NPI:1659632842
Name:RAJKUMAR, JENNIFER JO-ANN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO-ANN
Last Name:RAJKUMAR
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:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:
Practice Address - Street 1:5 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3601
Practice Address - Country:US
Practice Address - Phone:813-844-7473
Practice Address - Fax:813-844-1966
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.208072207Q00000X
VA0116024681207Q00000X
FLME134540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05602370Medicaid
LA2402587Medicaid
MS05602370Medicaid