Individual
JENNIFER AYSCUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
625 6TH AVE S, ST PETERSBURG, FL 33701-4662
(727) 893-6363
(727) 893-6364
Mailing address
625 6TH AVE S, ST PETERSBURG, FL 33701-4662
(727) 893-6363
(727) 893-6364
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD32652
DC
208C00000X
Colon & Rectal Surgery Physician
Primary
ME159244
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010103304
—
DC
01
—
022077W91
MEDICARE
DC
05
—
025804400
—
DC
05
—
699312500
—
DC
Enumeration date
01/10/2006
Last updated
09/10/2024
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