Healthcare Provider Details

I. General information

NPI: 1144670928
Provider Name (Legal Business Name): JENNIFER HISLOP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST FL 13
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST FL 13
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6732
  • Fax: 305-243-7098
Mailing address:
  • Phone: 305-243-6732
  • Fax: 305-243-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL39673
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number86629-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME146113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: