Provider Demographics
NPI:1174899165
Name:HOANG, JESSIE LENA (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:LENA
Last Name:HOANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSIE
Other - Middle Name:LENA
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 5TH S S,
Mailing Address - Street 2:DEPT #6500002705
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-3051
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:1700 S TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-0000
Practice Address - Country:US
Practice Address - Phone:941-917-7490
Practice Address - Fax:941-917-1308
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123520208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015605500Medicaid