Healthcare Provider Details

I. General information

NPI: 1932917101
Provider Name (Legal Business Name): JENNIFER LENE WOFFORD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MARKET ST
LOUISVILLE KY
40202-1969
US

IV. Provider business mailing address

3191 HARBOR BLVD STE A
PORT CHARLOTTE FL
33952-6755
US

V. Phone/Fax

Practice location:
  • Phone: 502-579-8253
  • Fax:
Mailing address:
  • Phone: 941-883-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11036263
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4030684
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: