Healthcare Provider Details

I. General information

NPI: 1245940402
Provider Name (Legal Business Name): TYLER JENKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST FL 8
BALTIMORE MD
21202-3180
US

IV. Provider business mailing address

850 TOWBIN AVE
LAKEWOOD NJ
08701-5928
US

V. Phone/Fax

Practice location:
  • Phone: 833-599-2560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86565
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86564
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: