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NPI Code Detail

MEDICARE: DR. JENNIFER ANASTASIA WHITELOCK MD, MPH

MEDICARE: DR. JENNIFER ANASTASIA WHITELOCK MD, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianME169123FL

General Provider Information

NPI Number : 1477896314
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER ANASTASIA WHITELOCK MD, MPH
Provider Business Mailing Address
First Line : 4425 MERRIMAC AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-1850
Country : US
Telephone Number : 904-431-0700
Fax Number :
Provider Business Practice Location Address
First Line : 4425 MERRIMAC AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-1850
Country : US
Telephone Number : 904-431-0700
Fax Number : 904-212-0780
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2013
Last Update Date : 03/13/2025

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