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NPI Code Detail

MEDICARE: JAZMINE L CHURCH

MEDICARE: JAZMINE L CHURCH
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
1106S00000XBehavior TechnicianRBT-24-381960FL

General Provider Information

NPI Number : 1104635440
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAZMINE L CHURCH
Provider Business Mailing Address
First Line : PO BOX 2112
Second Line :
City : LAKELAND
State : FL
Zip : 33806-2112
Country : US
Telephone Number : 863-581-1583
Fax Number : 863-644-9590
Provider Business Practice Location Address
First Line : 11602 N 51ST ST
Second Line :
City : TAMPA
State : FL
Zip : 33617-2132
Country : US
Telephone Number : 863-581-1583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2025
Last Update Date : 03/12/2026

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Directions to “ JAZMINE L CHURCH ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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