Healthcare Provider Details

I. General information

NPI: 1649155458
Provider Name (Legal Business Name): JENNA GWINN RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 PINES BLVD 305
PEMBROKE PINES FL
33024-6422
US

IV. Provider business mailing address

9050 PINES BLVD STE 305
PEMBROKE PINES FL
33024-6422
US

V. Phone/Fax

Practice location:
  • Phone: 754-704-6867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW22312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: