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NPI Code Detail

MEDICARE: JENNIFER VINSON

MEDICARE: JENNIFER VINSON
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
1222Q00000XDevelopmental Therapist

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 : 1558786418
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER VINSON
Provider Business Mailing Address
First Line : 447 BELLA VIDA BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32828-6717
Country : US
Telephone Number : 803-443-1353
Fax Number :
Provider Business Practice Location Address
First Line : 447 BELLA VIDA BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32828-6717
Country : US
Telephone Number : 803-443-1353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2014
Last Update Date : 06/04/2014

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