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General NPI Number Information
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NPI Number | 1245151174
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Entity Type | Individual
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Provider Name | JAYLEN EARNEST TOLIVER
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Gender | Male
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 1265 SW 101ST TER APT 210
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-5049
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Country | US
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Telephone | 954-997-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 5306 PLUNKETT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA109252
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License Number State | FL
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