Provider Demographics
NPI:1942318191
Name:SUMMERS, JANICE ALEXANDRA (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ALEXANDRA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2945
Mailing Address - Country:US
Mailing Address - Phone:727-709-5058
Mailing Address - Fax:727-954-4633
Practice Address - Street 1:5015 4TH ST N STE B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2945
Practice Address - Country:US
Practice Address - Phone:727-709-5058
Practice Address - Fax:727-954-4633
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG55506Medicare UPIN