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General NPI Number Information
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NPI Number | 1306740485
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Entity Type | Individual
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Provider Name | TABITA JEROME
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Gender | Female
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 12724 GRAN BAY PKWY W STE 410
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City | JACKSONVILLE
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State | FL
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Zip | 32258-9486
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Country | US
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Telephone | 855-832-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 FIRST COAST TECH PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32224-0606
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Country | US
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Telephone | 954-512-8152
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | FL
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