Jessica Renneisen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9110877 Issued in FL

Practice address

4725 N Federal Hwy
Fort Lauderdale, FL 33308-4603

Phone

(954) 414-9750

NPI assigned

Dec 2, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: jrenneisen2019712@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Holy Cross Hospital Inc

  • Internal Medicine Physician
  • Ft. Lauderdale, FL
  • NPI 1467401877
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1730694597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100296",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100296",
            "telephone_number": "352-627-9350",
            "fax_number": "352-273-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 N FEDERAL HWY",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333084603",
            "telephone_number": "954-414-9750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNEISEN",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-12-02",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renewed Mind and Health
• Lenny Maritza Rengifo Hernandez
• Pablo A Rengifo-Moreno, M.D.
• Tina Capule Reniedo, PT
• Sarah Renken, M.S. CCC-SLP
• Andrew C Rennick, MD
• Res-Care Premier, Inc.
• Michael Resnick, DDS MPH
• Resolve Primary and Mental Healthcare LLC
• Responsive Home Health, Inc.

• Physician Assistant in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.