Healthcare Provider Details

I. General information

NPI: 1497756944
Provider Name (Legal Business Name): JENNIFER R MCCULLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 LAKEWOOD RANCH BLVD STE 240
LAKEWOOD RANCH FL
34202-5180
US

IV. Provider business mailing address

8340 LAKEWOOD RANCH BLVD STE 240
LAKEWOOD RANCH FL
34202-5180
US

V. Phone/Fax

Practice location:
  • Phone: 941-907-3008
  • Fax: 941-907-3036
Mailing address:
  • Phone: 941-907-3008
  • Fax: 941-907-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0066257
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0066257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: