MEDICARE: DARRYL ANTHONY JENKINS JR.

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	106S00000X	Behavior Technician	RBT-24-386978	FL
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1396562807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRYL ANTHONY JENKINS JR.

Provider Business Mailing Address
First Line	:	478 N BABCOCK ST STE 115
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-6923
Country	:	US
Telephone Number	:	321-972-4265
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 STEWART PL
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-4304
Country	:	US
Telephone Number	:	321-831-7834
Fax Number	:

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

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	10/22/2024

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