Individual
JENNIFER FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
@ COLUMBIA DRIVE, J402, TAMPA, FL 33606
(813) 844-7412
Mailing address
@ COLUMBIA DRIVE, J402, TAMPA, FL 33606
(813) 844-7412
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME106514
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002280100
—
FL
01
—
148MZ
FL BCBS
FL
Enumeration date
08/30/2007
Last updated
09/23/2010
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