Provider Demographics
NPI:1063527596
Name:SEATON, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SEATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BEAL PKWY NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1446
Mailing Address - Country:US
Mailing Address - Phone:850-362-6435
Mailing Address - Fax:
Practice Address - Street 1:1025 BEAL PKWY NW
Practice Address - Street 2:SUITE C
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1446
Practice Address - Country:US
Practice Address - Phone:850-362-6435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98995207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25132OtherBCBS OF FLORIDA
FL280851000Medicaid
I69515Medicare UPIN
FL25132OtherBCBS OF FLORIDA