Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME99389 | FL |
N | 207XS0106X | Orthopaedic Hand Surgeon | ME99389 | FL |
N | 207XX0801X | Orthopaedic Trauma Surgeon | ME99389 | FL |
Y | 2086S0105X | Surgery of the Hand | ME99389 | FL |
NPI | 1619995388 |
---|---|
Provider Name | Jennifer L Madden |
First Address | Jacksonville, FL 32203-0767 |
Second Address | Jacksonville, FL 32258-2645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
279103000 | (05) | FL |
I 39544 | (02) | |
P00433235 | RR MEDICARE (01) | FL |