Provider Demographics
NPI:1386078699
Name:CEJAS, JENNIFER MILLER (AUD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MILLER
Last Name:CEJAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-780-1255
Mailing Address - Fax:
Practice Address - Street 1:36763 EILAND BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-0600
Practice Address - Country:US
Practice Address - Phone:813-973-8400
Practice Address - Fax:813-355-5077
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY861231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009855200Medicaid
FLHO387Y - TAMPAMedicare PIN
FLHO387Z - PASCOMedicare PIN