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General NPI Number Information
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NPI Number | 1114151933
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Entity Type | Individual
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Provider Name | THUY LINH THI PENEDO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 800 PRUDENTIAL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8202
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Country | US
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Telephone | 904-202-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 203 INDIGO DR
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City | BRUNSWICK
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State | GA
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Zip | 31525-6865
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Country | US
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Telephone | 912-261-2669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | 77393
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 30675
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 124257
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License Number State | FL
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