Provider Demographics
NPI:1215279476
Name:RIEMER, JERETTA LEIGHANN (DO)
Entity type:Individual
Prefix:
First Name:JERETTA
Middle Name:LEIGHANN
Last Name:RIEMER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3109 W DR MARTIN LUTHER KING JR BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6208
Mailing Address - Country:US
Mailing Address - Phone:833-208-7770
Mailing Address - Fax:833-464-3584
Practice Address - Street 1:3109 W DR MARTIN LUTHER KING JR BLVD BLDG SUITE350
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6260
Practice Address - Country:US
Practice Address - Phone:833-208-7770
Practice Address - Fax:833-450-0456
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics