Provider Demographics
NPI:1720230360
Name:ANTON, JENNIFER TUCKER (BSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TUCKER
Last Name:ANTON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-2621
Mailing Address - Country:US
Mailing Address - Phone:407-413-9550
Mailing Address - Fax:
Practice Address - Street 1:1708 LEXINGTON GREEN LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1018
Practice Address - Country:US
Practice Address - Phone:407-413-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst