Provider Demographics
NPI:1992094510
Name:WHITE, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:LUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:813-778-0820
Mailing Address - Fax:813-355-5101
Practice Address - Street 1:2352 BRUCE B DOWNS BLVD STE 204
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9203
Practice Address - Country:US
Practice Address - Phone:813-994-1286
Practice Address - Fax:813-355-5031
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126609208M00000X, 207R00000X
LA206759208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018160500Medicaid
LA2371134Medicaid
FLIQ351ZMedicare PIN