Healthcare Provider Details

I. General information

NPI: 1255244851
Provider Name (Legal Business Name): JAZMYNE BRUNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 MORROW ST E STE 203
JACKSONVILLE FL
32217-2126
US

IV. Provider business mailing address

13444 GRAN BAY PKWY APT 638
JACKSONVILLE FL
32258-7424
US

V. Phone/Fax

Practice location:
  • Phone: 407-549-8378
  • Fax:
Mailing address:
  • Phone: 407-549-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: