JENNIFER MICHELLE DIVINE (NPI# 1063779072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063779072 |
| Entity Type | Individual |
| Full Name | JENNIFER MICHELLE DIVINE |
| Other Name | JENNIFER MICHELLE CORBIN |
| Credential | MD |
| Practice Address |
12901 Bruce B Downs Blvd Mdc 41 Tampa FL 33612-4742 |
| Mailing Address |
1260 Doctor's Lane Fort Collins CO 80524 |
| Practice Telephone | 8138447412 |
| Practice Fax Number | 8139748359 |
| Enumeration Date | 2012-04-15 |
| Last Update Date | 2017-04-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
ME 131766 | FL | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
DR.0058205 | CO | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588127468 | Jennifer Mariko Izumi Divine | Student in an Organized Health Care Education/Training Program | 1701 N Senate Blvd # Ag012, Indianapolis, IN 46202-1239 | 2019-04-09 |
| Street Address |
12901 BRUCE B DOWNS BLVD MDC 41 |
| City | TAMPA |
| State | FL |
| Zip Code | 33612-4742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629076799 | Gonzalo Mantilla | Pediatrics | 12901 Bruce B Downs Blvd, Mdc 15, Tampa, FL 33612-4742 | 2005-07-12 |
| 1538796784 | Samia Valeria Ozorio Dutra | Registered Nurse | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2020-03-26 |
| 1255966289 | Jessica Huang | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2020-03-10 |
| 1487218764 | Chelsea Gebs Black | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612-4742 | 2019-04-23 |
| 1609430925 | Kathryn Elizabeth Rudibaugh | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-23 |
| 1467015883 | Thomas Cole | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2019-04-22 |
| 1417510751 | Kelly Powell | Physician Assistant | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-22 |
| 1700347283 | Kristopher Johnson | Nurse Practitioner | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4799 | 2019-03-27 |
| 1366909129 | Derrik Jose Diaz Navarro | Specialist/Technologist | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4742 | 2019-02-27 |
| 1346717717 | Kyle William Woodward | Specialist/Technologist | 12901 Bruce B Downs Blvd, Tampa, FL 33612-4799 | 2018-10-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689286767 | Daniel Jimenez | Physical Therapist | 13000 Bruce B Downs Blvd, Tampa, Fl, Tampa, FL 33612 | 2020-08-19 |
| 1700426830 | Taz Stacy | Behavior Technician | 2701 University Square Drive, Tampa, FL 33612 | 2020-01-07 |
| 1841853215 | Eric Austen Keeler | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-20 |
| 1346700242 | Caitlyn Victoria Cartwright | Student in an Organized Health Care Education/Training Program | 12901 Bruce B. Downs Blvd., Mdc5, Tampa, FL 33612 | 2019-03-25 |
| 1720552953 | Marijo Bilitski | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd # Blvd5, Tampa, FL 33612 | 2019-01-22 |
| 1790259190 | Belkis Aleman | Nurse Practitioner | 205 E Busch Blvd, Tampa, FL 33612 | 2019-01-18 |
| 1811469133 | Stephanie Stegner | Physician Assistant | 12901 Bruce B Downs Blvd Mdc 5, Tampa, FL 33612 | 2018-12-27 |
| 1053889857 | Alysia Heather Siegel | Psychologist | 1300 Bruce B. Downs Boulevard, 116b, Tampa, FL 33612 | 2018-11-09 |
| 1295202489 | Daisy Baby Pulinilkumkalayil | Nurse Practitioner | 1426 W. Bush Blvd. Suite #105, Suite #105, Tampa, FL 33612 | 2018-10-26 |
| 1649745258 | Rachel Rene Shelton | Specialist/Technologist | Orthopedics and Sports Medicine, 13330 Usf Laurel Drive, Tampa, FL 33612 | 2018-10-10 |
| Find all providers in zip 33612 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558378141 | Paul Herschel Bowman Md | Dermatology | 5379 Primrose Lake Circle, Tampa, FL 33647 | 2006-08-03 |
| 1508812983 | Steven Al Proper | Dermatology | 14521 University Point Pl, Tampa, FL 33613-5424 | 2006-05-26 |
| 1184670903 | Paul H Bowman | Dermatology | 5379 Primrose Lake Cir, Tampa, FL 33647-3521 | 2006-05-25 |
| 1275854614 | Nicole Marie Howe | Dermatology | 15416 N Florida Ave, Tampa, FL 33613-1244 | 2010-06-21 |
| 1649438144 | Leavitt Medical Associates of Florida Inc | Dermatology | 6919 N Dale Mabry Hwy, Ste 325, Tampa, FL 33614-3972 | 2008-05-30 |
| 1619081155 | Patrick Michael Ellison | Dermatology | 8415 Bayshore Blvd, Tampa, FL 33621-1607 | 2006-08-19 |
| 1538119722 | Academic Alliance In Dermatology, Inc. | Dermatology | 5210 Webb Rd, Tampa, FL 33615-4518 | 2006-05-11 |
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| 1942855150 | International Dermatology Research, Inc. | Dermatology | 8370 W Flagler St Ste 200, Miami, FL 33144-2038 | 2019-08-05 |
| 1154815546 | Forefront Dermatology, S.c. | Dermatology | 7720 Us Highway 98 W Ste 240, Miramar Beach, FL 32550-7232 | 2018-06-19 |
| 1437517802 | Total Vein and Skin LLC | Dermatology | 10383 Hagen Ranch Road, Ste 100, Boynton Beach, FL 33437-3732 | 2016-02-01 |
| 1861812851 | Anand Haryani | Dermatology | 8745 N Us Highway 1, Sebastian, FL 32958-7524 | 2014-04-17 |
| 1164841797 | Michael Montuno | Dermatology | 38135 Market Sq Ste 108, Zephyrhills, FL 33542-7505 | 2014-04-10 |
| 1861813719 | Hillcrest Dermatology and Plastic Surgery P.a. | Dermatology | 733 Highway 466, Lady Lake, FL 32159-6340 | 2013-12-19 |
| 1922355957 | Florida Medical Specialists | Dermatology | 4351 Cortez Rd W, Suite 101, Bradenton, FL 34210 | 2012-08-09 |
| 1619232501 | Alliant Dermatology Pa | Dermatology | 8620 E County Road 466, The Villages, FL 32162-3670 | 2012-07-07 |
| 1114218328 | Leavitt Medical Assocaittes of Florida Inc | Dermatology | 1426 E Bloomindale Ave, Valrico, FL 33596 | 2011-04-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.