Provider Demographics
NPI:1396800579
Name:CLEMENTI, JENNIFER LYN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYN
Last Name:CLEMENTI
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 1:8451 SHADE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2878
Mailing Address - Country:US
Mailing Address - Phone:941-360-1266
Mailing Address - Fax:941-360-1369
Practice Address - Street 1:8451 SHADE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2878
Practice Address - Country:US
Practice Address - Phone:941-360-1266
Practice Address - Fax:941-360-1369
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96587208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME96587OtherLICENSE