Provider Demographics
NPI:1740246644
Name:CANCEL, JEANETTE (MD)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:CANCEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4440 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1926
Mailing Address - Country:US
Mailing Address - Phone:941-366-0134
Mailing Address - Fax:414-041-7609
Practice Address - Street 1:2349 SUNSET POINT RD STE 405
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1439
Practice Address - Country:US
Practice Address - Phone:727-216-6193
Practice Address - Fax:877-868-0981
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55080207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089152OtherMEDICARE ID - PROVIDER NUMBER
PRF40879Medicare UPIN