Provider Demographics
NPI:1891113957
Name:HYDE, JENSEN HART (MD)
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:HART
Last Name:HYDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENSEN
Other - Middle Name:ELLEN
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:975 E 3RD ST - ATTN: PROVIDER ENROLLMENT
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-661-7718
Mailing Address - Fax:423-778-2108
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-661-7718
Practice Address - Fax:423-778-2108
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine