Healthcare Provider Details

I. General information

NPI: 1851221188
Provider Name (Legal Business Name): JENNIFER ANDREA INNOCENT I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301A W PALMETTO PARK RD
BOCA RATON FL
33433-3409
US

IV. Provider business mailing address

7209 SW 4TH ST
NORTH LAUDERDALE FL
33068-1409
US

V. Phone/Fax

Practice location:
  • Phone: 954-248-1171
  • Fax:
Mailing address:
  • Phone: 754-244-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: