Healthcare Provider Details

I. General information

NPI: 1891618617
Provider Name (Legal Business Name): JAZMINE ROSARIO ALVIAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5945 US 301 N
ELLENTON FL
34222-2953
US

IV. Provider business mailing address

5945 US 301 N
ELLENTON FL
34222-2953
US

V. Phone/Fax

Practice location:
  • Phone: 941-722-2884
  • Fax:
Mailing address:
  • Phone: 941-722-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI45891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: