Healthcare Provider Details

I. General information

NPI: 1699211292
Provider Name (Legal Business Name): JESSICA NENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 SW 46TH AVE UNIT 2101
POMPANO BEACH FL
33069-6450
US

IV. Provider business mailing address

1263 SW 46TH AVE UNIT 2101
POMPANO BEACH FL
33069-6450
US

V. Phone/Fax

Practice location:
  • Phone: 954-479-2158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: