Provider Demographics
NPI:1770265399
Name:MARKS, JEN (DIHOM, DHM, CCH)
Entity type:Individual
Prefix:
First Name:JEN
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:DIHOM, DHM, CCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 GRANITE DUST PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1415
Mailing Address - Country:US
Mailing Address - Phone:727-560-7699
Mailing Address - Fax:
Practice Address - Street 1:5214 GRANITE DUST PL
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1415
Practice Address - Country:US
Practice Address - Phone:727-560-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath