Provider Demographics
NPI:1790748416
Name:FLEEMAN, JENNIFER ANNE (PSYD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:FLEEMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:BADGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4744 CHARLES PARTIN DR
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-1242
Mailing Address - Country:US
Mailing Address - Phone:727-510-2721
Mailing Address - Fax:
Practice Address - Street 1:1411 N WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4515
Practice Address - Country:US
Practice Address - Phone:813-844-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9336103TC0700X
NY015572103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY121968FDOtherPREFERRED CARE NEUROPSYCH
NY02426277Medicaid
NYG0184796190OtherBLUECROSSBLUESHIELD GROUP
NY121968FCOtherPREFERRED CARE PSYCH
NYP010015572OtherBLUECROSSBLUESHIELD INDIV
NYP010015572OtherBLUECROSSBLUESHIELD INDIV