Healthcare Provider Details

I. General information

NPI: 1528027489
Provider Name (Legal Business Name): JENNIFER L. ST. CROIX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 VIRGINIA WOODS PL
ARLINGTON TN
38002-6113
US

IV. Provider business mailing address

2799 VIRGINIA WOODS PL
ARLINGTON TN
38002-6113
US

V. Phone/Fax

Practice location:
  • Phone: 901-413-5992
  • Fax:
Mailing address:
  • Phone: 901-413-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47465
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number47465
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01063263A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01063263A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD0000044753
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: