Healthcare Provider Details

I. General information

NPI: 1154640100
Provider Name (Legal Business Name): JENNIFER ELIZABETH PAYNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

IV. Provider business mailing address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 850-969-2038
  • Fax: 850-969-2037
Mailing address:
  • Phone: 850-969-2038
  • Fax: 850-969-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25511
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME 118750
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA127225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: