Healthcare Provider Details

I. General information

NPI: 1720016157
Provider Name (Legal Business Name): JENNIFER DEASON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ESTRADA SQ
HOBE SOUND FL
33455-2400
US

IV. Provider business mailing address

100 ESTRADA SQ
HOBE SOUND FL
33455-2400
US

V. Phone/Fax

Practice location:
  • Phone: 772-546-3751
  • Fax: 772-545-0999
Mailing address:
  • Phone: 772-546-3751
  • Fax: 772-545-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME84826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: