Provider Demographics
NPI:1841311610
Name:NORMAN, JERI A (DO)
Entity type:Individual
Prefix:MRS
First Name:JERI
Middle Name:A
Last Name:NORMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:11138 THONOTOSASSA RD
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-3001
Mailing Address - Country:US
Mailing Address - Phone:813-986-6718
Mailing Address - Fax:
Practice Address - Street 1:13391 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:813-899-1705
Practice Address - Fax:813-899-2805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OS5840OtherLIC
OS5840OtherLIC
FL20-5026366OtherEIN
BN4909632OtherDEA