Healthcare Provider Details

I. General information

NPI: 1568372514
Provider Name (Legal Business Name): JODI PENCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5260 78TH AVE N UNIT 1697
PINELLAS PARK FL
33780-8068
US

IV. Provider business mailing address

405 MOUNT VIEW DR
PARIS KY
40361-1027
US

V. Phone/Fax

Practice location:
  • Phone: 727-492-8401
  • Fax:
Mailing address:
  • Phone: 859-321-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1162548
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: