Healthcare Provider Details

I. General information

NPI: 1306004361
Provider Name (Legal Business Name): CHRISTOPHER J JENNY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 COUNTRY PLACE BLVD BLDG B
TRINITY FL
34655-1163
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-8200
  • Fax: 813-844-1114
Mailing address:
  • Phone: 813-844-8927
  • Fax: 813-844-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110090
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102778
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: