MEDICARE: ISANGEL MILMAR PENA

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	103K00000X	Behavior Analyst	1-25-84532	FL
2	106S00000X	Behavior Technician

Other Identifiers

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

General Provider Information

NPI Number	:	1417730433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISANGEL MILMAR PENA

Provider Business Mailing Address
First Line	:	3976 BLOOMFIELD CT
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-4484
Country	:	US
Telephone Number	:	904-352-6696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 JORK RD STE 401-402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-2491
Country	:	US
Telephone Number	:	904-662-7093
Fax Number	:

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	11/20/2025

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Directions to “ ISANGEL MILMAR PENA ” Practice Location

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