Basic Information
Provider Information
NPI: 1003010307
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STONE
FirstName: JENNIFER
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1570 ISLAND LN
Address2:  
City: ORANGE PARK
State: FL
PostalCode: 320037453
CountryCode: US
TelephoneNumber: 9042641204
FaxNumber: 9042641227
Practice Location
Address1: 1570 ISLAND LN
Address2:  
City: ORANGE PARK
State: FL
PostalCode: 320037453
CountryCode: US
TelephoneNumber: 9042641204
FaxNumber: 9042641227
Other Information
ProviderEnumerationDate: 06/12/2007
LastUpdateDate: 05/23/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME111724FLY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X2007-00575NCN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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