Healthcare Provider Details

I. General information

NPI: 1104604396
Provider Name (Legal Business Name): JESSICA BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27357 FRAMPTON AVE
BROOKSVILLE FL
34602-7306
US

IV. Provider business mailing address

4164 OASIS AVE
SPRING HILL FL
34609-2242
US

V. Phone/Fax

Practice location:
  • Phone: 813-610-2982
  • Fax:
Mailing address:
  • Phone: 352-777-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-286485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: