Healthcare Provider Details

I. General information

NPI: 1467367789
Provider Name (Legal Business Name): ELLE ROUMI RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 WHITE CEDAR TRL
JACKSONVILLE FL
32226-5032
US

IV. Provider business mailing address

12665 WHITE CEDAR TRL
JACKSONVILLE FL
32226-5032
US

V. Phone/Fax

Practice location:
  • Phone: 904-535-0660
  • Fax: 888-580-6733
Mailing address:
  • Phone: 904-535-0660
  • Fax: 888-580-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-26-2840743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: