Individual
JESSICA IBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-4673
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
283381
MA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME149925
FL
208VP0014X
Interventional Pain Medicine Physician
ME149925
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2016
Last updated
03/28/2022
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