Provider Demographics
NPI:1821023029
Name:PLATZ, JENNIFER ANN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:PLATZ
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 1:5100 N OCEAN BLVD
Mailing Address - Street 2:#507
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3036
Mailing Address - Country:US
Mailing Address - Phone:954-493-7497
Mailing Address - Fax:
Practice Address - Street 1:10 FAIRWAY DR
Practice Address - Street 2:SUITE 122
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1812
Practice Address - Country:US
Practice Address - Phone:954-725-9263
Practice Address - Fax:954-725-9264
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health