MEDICARE: DR. JENNIFER M. GILLETTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY 8276	FL
2	103G00000X	Clinical Neuropsychologist	PY 8276	FL

General Provider Information

NPI Number	:	1578855698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER M. GILLETTE

Provider Business Mailing Address
First Line	:	3790 SW 106TH TER
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-1309
Country	:	US
Telephone Number	:	954-257-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	10650 W STATE ROAD 84 STE 211
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4235
Country	:	US
Telephone Number	:	954-257-0711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2011
Last Update Date	:	03/13/2026

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