Provider Demographics
NPI:1124699475
Name:JAENICKE, DEBORAH (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:JAENICKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:SHIMSHONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:86 W UNDERWOOD ST STE 2001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:407-841-5133
Mailing Address - Fax:407-237-6313
Practice Address - Street 1:86 W UNDERWOOD ST STE 2001
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:407-841-5133
Practice Address - Fax:407-237-6313
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME167860207P00000X
FLTRN32848390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program