Provider Demographics
NPI:1669593513
Name:MENNIE, JOCELYN MAE (MD)
Entity type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:MAE
Last Name:MENNIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:11G
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-979-2433
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:11G
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-979-2433
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC52314207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52314OtherCALIFORNIA MEDICAL BOARD