Healthcare Provider Details

I. General information

NPI: 1649184177
Provider Name (Legal Business Name): JENNIFER PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 216TH ST
CUTLER BAY FL
33190-1003
US

IV. Provider business mailing address

16851 SW 77TH AVE
PALMETTO BAY FL
33157-4805
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • Fax:
Mailing address:
  • Phone: 305-253-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: