Provider Demographics
NPI:1144328238
Name:UDZINSKI, JENNIFER ANNE (MS PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:UDZINSKI
Suffix:
Gender:F
Credentials:MS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4981 SW SAINT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8815
Mailing Address - Country:US
Mailing Address - Phone:772-631-6493
Mailing Address - Fax:
Practice Address - Street 1:938 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2816
Practice Address - Country:US
Practice Address - Phone:772-223-6410
Practice Address - Fax:772-223-0092
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102799363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ23658Medicare UPIN
FLU3252ZMedicare ID - Type Unspecified