Provider Demographics
NPI:1730391426
Name:CUEVAS, JENNIFER LINDA (IDC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LINDA
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:304 N MCCARTHY AVE STE 117
Mailing Address - Street 2:NAVSCOLEOD/ RANGE MEDICAL
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-5630
Mailing Address - Country:US
Mailing Address - Phone:850-882-6476
Mailing Address - Fax:
Practice Address - Street 1:304 N MCCARTHY AVE STE 117
Practice Address - Street 2:NAVSCOLEOD
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-5630
Practice Address - Country:US
Practice Address - Phone:850-832-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman