Provider Demographics
NPI:1801021894
Name:JENSEN, PRECEOUSA SERNA (DO, PMH)
Entity Type:Individual
Prefix:
First Name:PRECEOUSA
Middle Name:SERNA
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DO, PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:DEPT #6590070301
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4313
Mailing Address - Fax:727-767-4971
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:DEPT #6590070301
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4313
Practice Address - Fax:727-767-4971
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS141302080N0001X
DCDO0345192080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program