Individual
DR. JENNIFER MOSCOSO CONDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5627 SKYOP DRIVE, LITHIA, FL 33547
(813) 530-6511
Mailing address
5627 SKYTOP DR, LITHIA, FL 33547-4165
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS12902
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IZ758Z
MEDICARE
FL
Enumeration date
06/29/2014
Last updated
03/16/2024
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