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General NPI Number Information
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NPI Number | 1922549781
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Entity Type | Individual
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Provider Name | JENNIFER PECORA LCP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 215 1ST ST N STE 300A
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4537
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Country | US
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Telephone | 863-471-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 3129 WALNUT ST
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City | WINTER HAVEN
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State | FL
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Zip | 33881-1163
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Country | US
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Telephone | 352-514-4445
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PRO 170
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License Number State | FL
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