Healthcare Provider Details

I. General information

NPI: 1629565999
Provider Name (Legal Business Name): JENNIFER MARIKO THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 N MACDILL AVE STE 407
TAMPA FL
33607-6396
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-217-9384
  • Fax: 813-443-8167
Mailing address:
  • Phone: 727-532-0002
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME150409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: