Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | OS14414 | FL |
Y | 207VX0201X | Gynecologic Oncologist | OS14414 | FL |
NPI | 1225477607 |
---|---|
Provider Name | Jessica Kennard |
First Address | Tampa, FL 33622-5317 |
Second Address | St Petersburg, FL 33713-7147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 19/08/2020 |