Healthcare Provider Details

I. General information

NPI: 1144095456
Provider Name (Legal Business Name): JACQUELINE OLIVIA SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N STE 401
BOCA RATON FL
33428-2252
US

IV. Provider business mailing address

3200 HIDDEN HOLLOW LN
DAVIE FL
33328-6928
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax:
Mailing address:
  • Phone: 954-880-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: