Provider Demographics
NPI:1306881420
Name:CACERES, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CACERES
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 1:180 JFK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6607
Mailing Address - Country:US
Mailing Address - Phone:561-548-1540
Mailing Address - Fax:
Practice Address - Street 1:180 JFK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6607
Practice Address - Country:US
Practice Address - Phone:561-548-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274056700Medicaid
FLP0070D543OtherRR MEDICARE
FLP0070D543OtherRR MEDICARE
I38880Medicare UPIN
FLU5354XMedicare PIN