Healthcare Provider Details

I. General information

NPI: 1912411562
Provider Name (Legal Business Name): JENNA LEIGH RIPOLL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 NW 15TH ST
CAPE CORAL FL
33993-9579
US

IV. Provider business mailing address

3505 NW 15TH ST
CAPE CORAL FL
33993-9579
US

V. Phone/Fax

Practice location:
  • Phone: 817-480-2680
  • Fax: 324-204-1044
Mailing address:
  • Phone: 817-480-2680
  • Fax: 324-204-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: