Healthcare Provider Details

I. General information

NPI: 1184116535
Provider Name (Legal Business Name): JOANNA GERNAYE COLE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MURRELL RD # 100
MELBOURNE FL
32940-6700
US

IV. Provider business mailing address

1509 E COLONIAL DR STE 300
ORLANDO FL
32803-4729
US

V. Phone/Fax

Practice location:
  • Phone: 321-426-7759
  • Fax:
Mailing address:
  • Phone: 407-218-4371
  • Fax: 407-218-4303

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: