Provider Demographics
NPI:1023443470
Name:FRANCIS, JENNIFER LYNN (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 SOUTH FLORIDA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-647-3665
Mailing Address - Fax:863-647-2998
Practice Address - Street 1:3900 SOUTH FLORIDA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-647-3665
Practice Address - Fax:863-647-2998
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036722-1225100000X
FL29316225100000X
NCP14529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313539Medicaid
NY01815443Medicaid
NY01815443Medicaid
NY335475Medicare Oscar/Certification