MEDICARE: JENNIFER L. ST. CROIX MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	47465	WI
2	207P00000X	Emergency Medicine Physician	47465	WI
3	207P00000X	Emergency Medicine Physician	01063263A	IN
4	207Q00000X	Family Medicine Physician	01063263A	IN
5	207P00000X	Emergency Medicine Physician	MD0000044753	TN

General Provider Information

NPI Number	:	1528027489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L. ST. CROIX MD

Provider Business Mailing Address
First Line	:	2799 VIRGINIA WOODS PL
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-6113
Country	:	US
Telephone Number	:	901-413-5992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2799 VIRGINIA WOODS PL
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-6113
Country	:	US
Telephone Number	:	901-413-5992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	08/24/2013

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