Provider Demographics
NPI:1295788586
Name:MARX, JENNIFER B (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:MARX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2102 TRINITY OAKS BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4409
Mailing Address - Country:US
Mailing Address - Phone:727-372-2501
Mailing Address - Fax:813-635-2698
Practice Address - Street 1:2102 TRINITY OAKS BLVD STE 216
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4409
Practice Address - Country:US
Practice Address - Phone:727-372-2501
Practice Address - Fax:813-635-2698
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00101009OtherRAILROAD MEDICARE NUMBER
FL267821700Medicaid
FLP00101009OtherRAILROAD MEDICARE NUMBER
FL267821700Medicaid
FL78679ZMedicare PIN