MEDICARE: DR. JENNIFER MORANCY DPM

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
1	213E00000X	Podiatrist	PO4057	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871809160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MORANCY DPM

Provider Business Mailing Address
First Line	:	13600 ICOT BLVD BLDG A
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33760-3703
Country	:	US
Telephone Number	:	727-796-6900
Fax Number	:	727-669-8417

Provider Business Practice Location Address
First Line	:	13600 ICOT BLVD BLDG A
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33760-3703
Country	:	US
Telephone Number	:	727-796-6900
Fax Number	:	727-669-8417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	06/19/2020

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