Healthcare Provider Details

I. General information

NPI: 1528994704
Provider Name (Legal Business Name): JENNIFER LYNN RHODEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 LEE BLVD
LEHIGH ACRES FL
33971-1576
US

IV. Provider business mailing address

14932 PORTICO BLVD
FORT MYERS FL
33905-5987
US

V. Phone/Fax

Practice location:
  • Phone: 239-344-2391
  • Fax:
Mailing address:
  • Phone: 239-344-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH17434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: