Provider Demographics
NPI:1104880764
Name:OLES-DUGRE, JENNIFER A (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:OLES-DUGRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:OLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13820 OLD SAINT AUGUSTINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5424
Mailing Address - Country:US
Mailing Address - Phone:904-260-2565
Mailing Address - Fax:904-246-6878
Practice Address - Street 1:13820 OLD SAINT AUGUSTINE RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5424
Practice Address - Country:US
Practice Address - Phone:904-260-2565
Practice Address - Fax:904-246-6878
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12886208000000X
FLME 122982208000000X
MA231938208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010754300Medicaid
MA2140993Medicaid
FL010754300Medicaid
MA2140993Medicaid