Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20A11323 | CA |
N | 207Q00000X | Family Doctor | OS8792 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS8792 | FL |
NPI | 1184697062 |
---|---|
Provider Name | Dr. Jenifer Eimmerman |
First Address | Rosemont, IL 60018-4989 |
Second Address | Dania Beach, FL 33004-2252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A11323 | STATE LICENSE (01) | CA |
I43713 | (02) | FL |
OS8792 | FLORIDA STATE LICENSE (01) | |
U6143A | MEDICARE SUPPLIER NUMBER (01) | FL |