Healthcare Provider Details

I. General information

NPI: 1962202895
Provider Name (Legal Business Name): JENNIFER MERRINE MCGINNIS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CRESCENT PARK DR
RIVERVIEW FL
33578-3605
US

IV. Provider business mailing address

8801 HUNTERS LAKE DR APT 715
TAMPA FL
33647-2856
US

V. Phone/Fax

Practice location:
  • Phone: 813-492-8310
  • Fax:
Mailing address:
  • Phone: 813-904-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: