Healthcare Provider Details

I. General information

NPI: 1851323232
Provider Name (Legal Business Name): JENNY E DOLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S 5TH FLOOR DEPT 6941
ST PETERSBURG FL
33701
US

IV. Provider business mailing address

601 5TH ST S 5TH FLOOR DEPT 6941
ST PETERSBURG FL
33701
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-3051
  • Fax: 727-767-8420
Mailing address:
  • Phone: 727-767-3051
  • Fax: 727-767-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME92585
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME92585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: