Provider Demographics
NPI:1609325125
Name:DUVALL, JACQUELINE KIMBERLY (MA,BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:KIMBERLY
Last Name:DUVALL
Suffix:
Gender:F
Credentials:MA,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3350
Mailing Address - Country:US
Mailing Address - Phone:850-932-8021
Mailing Address - Fax:
Practice Address - Street 1:3208 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3350
Practice Address - Country:US
Practice Address - Phone:850-932-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-24488103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114278686OtherTRICARE