Healthcare Provider Details

I. General information

NPI: 1184697062
Provider Name (Legal Business Name): JENIFER EIMMERMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 NW 90TH BLVD
GAINESVILLE FL
32606-3809
US

IV. Provider business mailing address

9444 SW 27TH RD
GAINESVILLE FL
32608-7969
US

V. Phone/Fax

Practice location:
  • Phone: 352-378-2121
  • Fax:
Mailing address:
  • Phone: 954-232-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11323
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8792
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS8792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: