Healthcare Provider Details

I. General information

NPI: 1346164274
Provider Name (Legal Business Name): GILLETTE NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 W STATE ROAD 84 STE 211
DAVIE FL
33324-4235
US

IV. Provider business mailing address

3790 SW 106TH TER
DAVIE FL
33328-1309
US

V. Phone/Fax

Practice location:
  • Phone: 954-257-0711
  • Fax:
Mailing address:
  • Phone: 954-257-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER M GILLETTE
Title or Position: OWNER/NEUROPSYCHOLOGIST
Credential: PSY.D.
Phone: 954-257-0711