Healthcare Provider Details

I. General information

NPI: 1912405085
Provider Name (Legal Business Name): JENNIFER EVANS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 HORSESHOE DR S STE 404
NAPLES FL
34104-6155
US

IV. Provider business mailing address

2675 HORSESHOE DR S STE 404
NAPLES FL
34104-6155
US

V. Phone/Fax

Practice location:
  • Phone: 800-217-9289
  • Fax:
Mailing address:
  • Phone:
  • 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: