Healthcare Provider Details

I. General information

NPI: 1447600846
Provider Name (Legal Business Name): JENNA NIELSEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5806 OXFORD DR
TAMPA FL
33615-3732
US

IV. Provider business mailing address

5806 OXFORD DR
TAMPA FL
33615-3732
US

V. Phone/Fax

Practice location:
  • Phone: 813-906-5155
  • Fax:
Mailing address:
  • Phone: 813-906-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: