Healthcare Provider Details

I. General information

NPI: 1235864364
Provider Name (Legal Business Name): ASHLEY JENNY LOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 W TOWN CENTER BLVD
ORLANDO FL
32837-6100
US

IV. Provider business mailing address

2038 TIPTREE CIR
ORLANDO FL
32837-5792
US

V. Phone/Fax

Practice location:
  • Phone: 407-802-2774
  • Fax:
Mailing address:
  • Phone: 407-879-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2843172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: