Healthcare Provider Details

I. General information

NPI: 1508319963
Provider Name (Legal Business Name): JAZMINE ETIENNE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 S MISSOURI AVE APT 107
CLEARWATER FL
33756-9131
US

IV. Provider business mailing address

1102 S MISSOURI AVE APT 107
CLEARWATER FL
33756-9131
US

V. Phone/Fax

Practice location:
  • Phone: 727-831-8873
  • Fax:
Mailing address:
  • Phone: 727-831-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: