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NPI Code Detail

MEDICARE: JACQUELINE NICOLE DONOVAN BCBA

MEDICARE: JACQUELINE NICOLE DONOVAN BCBA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-19-37212FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134660996
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE NICOLE DONOVAN BCBA
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 : 886-610-0580
Fax Number : 886-610-0580
Provider Business Practice Location Address
First Line : 7000 LAKE ELLENOR DR
Second Line :
City : ORLANDO
State : FL
Zip : 32809-5749
Country : US
Telephone Number : 321-655-6585
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2017
Last Update Date : 09/20/2023

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