Basic Information
| Provider Information | |||||||||
| NPI: | 1992425680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDUZZI | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7555 CLAXSTRAUSS DR | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342409699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523143760 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Practice Location | |||||||||
| Address1: | 7555 CLAXSTRAUSS DR | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342409699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523143760 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2022 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-20-116762 | FL | Y | 193200000X MULTI-SPECIALTY GROUP |
ID Information
| ID | Type | State | Issuer | Description | 115296000 | 05 | FL | MEDICAID |