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NPI Code Detail

MEDICARE: JENNIFER RAE HOLT

MEDICARE: JENNIFER RAE HOLT
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

General Provider Information

NPI Number : 1316800907
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RAE HOLT
Provider Business Mailing Address
First Line : 13553 ATLANTIC BLVD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32225-4227
Country : US
Telephone Number : 904-420-7030
Fax Number :
Provider Business Practice Location Address
First Line : 13553 ATLANTIC BLVD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32225-4227
Country : US
Telephone Number : 904-420-7030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/09/2025

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