Provider Demographics
NPI:1184697062
Name:EIMMERMAN, JENIFER (DO)
Entity type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:
Last Name:EIMMERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 NW 79TH CT STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5791
Mailing Address - Country:US
Mailing Address - Phone:305-690-4801
Mailing Address - Fax:305-690-4871
Practice Address - Street 1:14900 NW 79TH CT STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5791
Practice Address - Country:US
Practice Address - Phone:305-690-4801
Practice Address - Fax:305-690-4871
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11323207Q00000X
FLOS8792207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6143AOtherMEDICARE SUPPLIER NUMBER
OS8792OtherFLORIDA STATE LICENSE
CA20A11323OtherSTATE LICENSE
FLI43713Medicare UPIN