Provider Demographics
NPI:1417390212
Name:FLUEGGE, JENNA ELYSE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ELYSE
Last Name:FLUEGGE
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 1:5029 96TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1318
Mailing Address - Country:US
Mailing Address - Phone:941-226-1435
Mailing Address - Fax:941-226-1437
Practice Address - Street 1:5029 96TH ST E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1318
Practice Address - Country:US
Practice Address - Phone:941-226-1435
Practice Address - Fax:941-226-1437
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144337207Q00000X
OH35.127696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107707600Medicaid