Healthcare Provider Details

I. General information

NPI: 1285534933
Provider Name (Legal Business Name): JENNIFER MARVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

9135 HUNTERS MILL DR
ORLANDO FL
32832-7067
US

V. Phone/Fax

Practice location:
  • Phone: 772-349-6317
  • Fax:
Mailing address:
  • Phone: 603-209-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: