Provider Demographics
NPI:1679807424
Name:SKOK, JENNIFER JOY (IDC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:SKOK
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOY
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDC
Mailing Address - Street 1:USS SAN ANTONIO
Mailing Address - Street 2:HM01/ MEDICAL
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09587-1700
Mailing Address - Country:US
Mailing Address - Phone:757-284-8722
Mailing Address - Fax:
Practice Address - Street 1:USS SAN ANTONIO
Practice Address - Street 2:HM01/ MEDICAL
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09587-1700
Practice Address - Country:US
Practice Address - Phone:757-284-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman