Healthcare Provider Details

I. General information

NPI: 1598001851
Provider Name (Legal Business Name): JENNIFER CRISTINA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14712 CHADBURY CT
ORLANDO FL
32828-7508
US

IV. Provider business mailing address

14712 CHADBURY CT
ORLANDO FL
32828-7508
US

V. Phone/Fax

Practice location:
  • Phone: 786-514-4027
  • Fax:
Mailing address:
  • Phone: 786-514-4027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: