Provider Demographics
NPI:1922297720
Name:KUCERA, JENNIFER NEVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NEVILLE
Last Name:KUCERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JEANNE
Other - Last Name:NEVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:DEPT #6580071400
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-3318
Practice Address - Fax:727-767-8002
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1106452085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008757500Medicaid