Healthcare Provider Details

I. General information

NPI: 1770420291
Provider Name (Legal Business Name): JASMINE NICOLE ELHANNAOUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N RICHARD JACKSON BLVD
PANAMA CITY BEACH FL
32407-3664
US

IV. Provider business mailing address

6121 HARVEY ST APT 1
CALLAWAY FL
32404-7553
US

V. Phone/Fax

Practice location:
  • Phone: 850-710-0741
  • Fax:
Mailing address:
  • Phone: 850-247-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1565445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: