Provider Demographics
NPI:1720493133
Name:DAVIS, JENN NICOLE (MS, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:JENN
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:2207 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1816
Mailing Address - Country:US
Mailing Address - Phone:850-814-2275
Mailing Address - Fax:850-770-2083
Practice Address - Street 1:4750 COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1000
Practice Address - Country:US
Practice Address - Phone:850-770-2241
Practice Address - Fax:850-770-2083
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst