Provider Demographics
NPI:1679943930
Name:PENICHET, JENNIFER T (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:PENICHET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15476 NW 77TH CT
Mailing Address - Street 2:#609
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5823
Mailing Address - Country:US
Mailing Address - Phone:786-303-7458
Mailing Address - Fax:
Practice Address - Street 1:12600 PEMBROKE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-431-7681
Practice Address - Fax:954-431-7682
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9328086363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily