Provider Demographics
NPI:1669009288
Name:LEE, JENNIFER HAEJOO
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAEJOO
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 LAKE NONA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-266-1199
Practice Address - Street 1:4600 SW 46TH CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5708
Practice Address - Country:US
Practice Address - Phone:352-291-3000
Practice Address - Fax:407-266-1199
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21208207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology