Healthcare Provider Details

I. General information

NPI: 1023937968
Provider Name (Legal Business Name): JENNIFER CAMILUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S MILITARY TRL STE D-E
WEST PALM BEACH FL
33415-3963
US

IV. Provider business mailing address

750 S MILITARY TRL STE D-E
WEST PALM BEACH FL
33415-3963
US

V. Phone/Fax

Practice location:
  • Phone: 571-337-8865
  • Fax: 561-299-4492
Mailing address:
  • Phone: 571-337-8865
  • Fax: 561-299-4492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26539278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: