Provider Demographics
NPI:1669604518
Name:JAKUBOWSKI, KINGA HANNA (OD)
Entity type:Individual
Prefix:
First Name:KINGA
Middle Name:HANNA
Last Name:JAKUBOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KINGA
Other - Middle Name:HANNA
Other - Last Name:JAKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:168 SUNLIT COVE DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3228
Mailing Address - Country:US
Mailing Address - Phone:727-744-5608
Mailing Address - Fax:
Practice Address - Street 1:2109 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4711
Practice Address - Country:US
Practice Address - Phone:727-744-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist