Provider Demographics
NPI:1861643322
Name:VINCENT, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 W COPELAND DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2028
Mailing Address - Country:US
Mailing Address - Phone:407-237-6319
Mailing Address - Fax:407-843-8505
Practice Address - Street 1:89 W COPELAND DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2028
Practice Address - Country:US
Practice Address - Phone:407-237-6319
Practice Address - Fax:407-843-8505
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME103768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000902600Medicare PIN