MEDICARE: JENICA JESSICA JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003558800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENICA JESSICA JONES

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	12013 MAGAZINE ST APT 8307
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-5508
Country	:	US
Telephone Number	:	561-603-0398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	04/12/2022

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Directions to “ JENICA JESSICA JONES ” Practice Location

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