MEDICARE: JENNY VERGEL NOA

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	RBT-23-314843	FL

General Provider Information

NPI Number	:	1538939483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY VERGEL NOA

Provider Business Mailing Address
First Line	:	1125 NE 9TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-3178
Country	:	US
Telephone Number	:	727-621-3044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 NE 9TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-3178
Country	:	US
Telephone Number	:	727-621-3044
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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