Provider Demographics
NPI:1427093145
Name:SWOBODA, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SWOBODA
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:PO BOX 538600
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32853-8600
Mailing Address - Country:US
Mailing Address - Phone:321-939-3553
Mailing Address - Fax:
Practice Address - Street 1:380 CELEBRATION PLACE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747
Practice Address - Country:US
Practice Address - Phone:321-939-3553
Practice Address - Fax:321-939-3552
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94996207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276159900Medicaid
FL53419OtherBCBS
FL53419OtherBCBS
FLU8634ZMedicare PIN