Healthcare Provider Details

I. General information

NPI: 1487147617
Provider Name (Legal Business Name): JILLIAN ZYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S FLORIDA AVE
LAKELAND FL
33801-4619
US

IV. Provider business mailing address

103 S FLORIDA AVE
LAKELAND FL
33801-4619
US

V. Phone/Fax

Practice location:
  • Phone: 813-438-8902
  • Fax: 813-438-8903
Mailing address:
  • Phone: 813-438-8902
  • Fax: 813-438-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-10851
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: