Healthcare Provider Details

I. General information

NPI: 1164056362
Provider Name (Legal Business Name): JENNIFER LEE OSORIO LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2746 N FLORIDA AVE
TAMPA FL
33602-1522
US

IV. Provider business mailing address

4212 N MARGUERITE ST
TAMPA FL
33603-3926
US

V. Phone/Fax

Practice location:
  • Phone: 813-515-0825
  • Fax:
Mailing address:
  • Phone: 850-803-3520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: