Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | ME103970 | FL |
NPI | 1316135437 |
---|---|
Provider Name | Suzanne M Jackman |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 31/07/2012 |