Healthcare Provider Details

I. General information

NPI: 1861327645
Provider Name (Legal Business Name): EDNA JENKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 SW PORT ST LUCIE BLVD
PORT ST LUCIE FL
34953-2618
US

IV. Provider business mailing address

737 SW PORT ST LUCIE BLVD
PORT ST LUCIE FL
34953-2618
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-5145
  • Fax: 561-816-4315
Mailing address:
  • Phone: 561-900-5145
  • Fax: 561-816-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-541902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: