Provider Demographics
NPI:1689249948
Name:PLASCENCIA, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PLASCENCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRISMA HEALTH INTERNAL MEDICINE CENTER
Mailing Address - Street 2:1801 SUNSET DRIVE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-4153
Mailing Address - Fax:803-434-4160
Practice Address - Street 1:PRISMA HEALTH INTERNAL MEDICINE CENTER
Practice Address - Street 2:1801 SUNSET DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-4153
Practice Address - Fax:803-434-4160
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SCLL861702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program