Provider Demographics
NPI:1952340374
Name:GOLDIN, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:GOLDIN
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 1:1277 N SEMORAN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3573
Mailing Address - Country:US
Mailing Address - Phone:407-447-7550
Mailing Address - Fax:407-447-7551
Practice Address - Street 1:1277 N SEMORAN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3573
Practice Address - Country:US
Practice Address - Phone:407-447-7550
Practice Address - Fax:407-447-7551
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82356207Q00000X
OH35077156G207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5972WMedicare PIN
FLH44780Medicare UPIN