Provider Demographics
NPI:1942565668
Name:NIEFELD, JENNA MEGAN (BA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MEGAN
Last Name:NIEFELD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 41ST ST STE 42
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3516
Mailing Address - Country:US
Mailing Address - Phone:305-604-9595
Mailing Address - Fax:305-604-9257
Practice Address - Street 1:400 W 41ST ST STE 402
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3500
Practice Address - Country:US
Practice Address - Phone:305-604-9595
Practice Address - Fax:305-604-9257
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1104962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty