Healthcare Provider Details

I. General information

NPI: 1275626780
Provider Name (Legal Business Name): JENNIFER B WARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11009 HEARTH RD
SPRING HILL FL
34608-3723
US

IV. Provider business mailing address

PO BOX 15430
BROOKSVILLE FL
34604-0118
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-5700
  • Fax: 352-688-5548
Mailing address:
  • Phone: 352-688-5700
  • Fax: 352-688-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME78321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: