Healthcare Provider Details

I. General information

NPI: 1801130711
Provider Name (Legal Business Name): JENNIFER AUGUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 NW 115TH ST
MIAMI FL
33168-2232
US

IV. Provider business mailing address

859 N.W. 115 STREET
MIAMI FL
33168-3565
US

V. Phone/Fax

Practice location:
  • Phone: 786-487-9519
  • Fax:
Mailing address:
  • Phone: 786-487-9519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: