Healthcare Provider Details

I. General information

NPI: 1134974827
Provider Name (Legal Business Name): MRS. JODI D FRISBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 SUGAR LEAF LN
LAKELAND FL
33810-7300
US

IV. Provider business mailing address

5302 S FLORIDA AVE STE 202
LAKELAND FL
33813-4910
US

V. Phone/Fax

Practice location:
  • Phone: 863-812-9129
  • Fax:
Mailing address:
  • Phone: 863-937-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: