Basic Information
| Provider Information | |||||||||
| NPI: | 1679943930 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PENICHET | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15476 NW 77TH CT | ||||||||
| Address2: | #609 | ||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863037458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12600 PEMBROKE RD | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330272544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544317681 | ||||||||
| FaxNumber: | 9544317682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 12/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9328086 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | ARNP9328086 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.