Healthcare Provider Details

I. General information

NPI: 1093115008
Provider Name (Legal Business Name): DIANA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 DUNLAP AVE SE
PALM BAY FL
32909-3717
US

IV. Provider business mailing address

244 DUNLAP AVE SE
PALM BAY FL
32909-3717
US

V. Phone/Fax

Practice location:
  • Phone: 321-344-0302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCABA0-11-4052
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCABA0-11-4052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: