Provider Demographics
NPI:1851688295
Name:CHEN, JENNY (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4881 NW 8TH AVE STE 2
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-401-7575
Mailing Address - Fax:352-401-7577
Practice Address - Street 1:3304 SW 34TH CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3358
Practice Address - Country:US
Practice Address - Phone:352-401-7575
Practice Address - Fax:352-401-7577
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2015-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME120738207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME120738OtherMEDICAL LICENSE
FLHZ578ZOtherMEDICARE PTAN