Provider Demographics
NPI:1730391640
Name:JENER, ANA GLORIA (ITDS)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:GLORIA
Last Name:JENER
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2630 PEARCE DR
Mailing Address - Street 2:#406
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-1129
Mailing Address - Country:US
Mailing Address - Phone:813-843-4457
Mailing Address - Fax:727-499-0926
Practice Address - Street 1:708 PEARL CIRCLE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4246
Practice Address - Country:US
Practice Address - Phone:813-431-8051
Practice Address - Fax:813-655-4814
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811607500Medicaid