Healthcare Provider Details

I. General information

NPI: 1700818515
Provider Name (Legal Business Name): JENNIFER T PLUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 CATTLERIDGE BLVD STE 102
SARASOTA FL
34232-6050
US

IV. Provider business mailing address

5969 CATTLERIDGE BLVD STE 102
SARASOTA FL
34232-6050
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-6647
  • Fax: 941-379-0611
Mailing address:
  • Phone: 941-379-6647
  • Fax: 941-379-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME92484
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME 92484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: