Provider Demographics
NPI:1689017345
Name:HUCKABEE, JENNIFER PARNAZ (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PARNAZ
Last Name:HUCKABEE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PARNAZ
Other - Last Name:BOROJERDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 GALLOWS RD
Mailing Address - Street 2:DEPT OF MEDICINE
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3307
Mailing Address - Country:US
Mailing Address - Phone:703-776-3582
Mailing Address - Fax:703-776-3020
Practice Address - Street 1:1600 SW ARCHER ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3001
Practice Address - Country:US
Practice Address - Phone:352-265-0291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-521172085R0202X
MN753252085R0202X
GUMC-1752085R0202X
GUMTL-2023-0272085R0202X
MO20240123932085R0202X
MDD866192085R0202X
FLME1637762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME163776OtherSTATE LICENSE