Healthcare Provider Details

I. General information

NPI: 1003369588
Provider Name (Legal Business Name): TAYLOR JAHNKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 CORSICA BLVD
COCOA FL
32927-4226
US

IV. Provider business mailing address

6535 CORSICA BLVD
COCOA FL
32927-4226
US

V. Phone/Fax

Practice location:
  • Phone: 321-355-0088
  • Fax:
Mailing address:
  • Phone: 321-355-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBHV-010676
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: