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NPI Code Detail

MEDICARE: MRS. JENNIFER MARIE POTTS RBT-17-40864

MEDICARE: MRS. JENNIFER MARIE POTTS RBT-17-40864
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
1103K00000XBehavior Analyst
2106S00000XBehavior Technician17-40864FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285141721
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER MARIE POTTS RBT-17-40864
Provider Business Mailing Address
First Line : 3771 STEFANI RD
Second Line :
City : CANTONMENT
State : FL
Zip : 32533-7795
Country : US
Telephone Number : 850-607-6910
Fax Number : 850-607-6932
Provider Business Practice Location Address
First Line : 495 GRAND BOULEVARD
Second Line : SUITE 206
City : MIRAMAR BEACH
State : FL
Zip : 32550-1408
Country : US
Telephone Number : 850-607-6910
Fax Number : 850-607-6932
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2018
Last Update Date : 03/14/2026

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