Provider Demographics
NPI:1902186455
Name:MOCKLER, JENNIFER LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:MOCKLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W HORATIO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-4104
Mailing Address - Country:US
Mailing Address - Phone:813-443-5722
Mailing Address - Fax:813-489-5355
Practice Address - Street 1:608 W HORATIO ST
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4104
Practice Address - Country:US
Practice Address - Phone:813-443-5722
Practice Address - Fax:813-489-5355
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist