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NPI Code Detail

MEDICARE: JENNIFER ELIZABETH MULLEN

MEDICARE: JENNIFER ELIZABETH MULLEN
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
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1841554615
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ELIZABETH MULLEN
Provider Business Mailing Address
First Line : 175 MIDDLE ST
Second Line : SUITE 1201
City : LAKE MARY
State : FL
Zip : 32746-3625
Country : US
Telephone Number : 866-610-0580
Fax Number :
Provider Business Practice Location Address
First Line : 11476 S APOPKA VINELAND RD
Second Line : SUITE 118
City : ORLANDO
State : FL
Zip : 32836-7006
Country : US
Telephone Number : 407-955-4001
Fax Number : 407-745-0738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2012
Last Update Date : 04/19/2017

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