Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD60855907 | WA |
Y | 208600000X | Surgeon | MD60855907 | WA |
NPI | 1003105289 |
---|---|
Provider Name | Dr. Jennifer Ann Minneman |
First Address | Tampa, FL 33622-1647 |
Second Address | Little Rock, AR 72205-5412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 04/02/2020 |