Healthcare Provider Details

I. General information

NPI: 1013842848
Provider Name (Legal Business Name): ZARIYAH JADE PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 NW SAINT LUCIE WEST BLVD # 1165
PORT SAINT LUCIE FL
34986-2501
US

IV. Provider business mailing address

637 SW JORDIN AVE
PORT SAINT LUCIE FL
34953-6450
US

V. Phone/Fax

Practice location:
  • Phone: 772-304-3514
  • Fax:
Mailing address:
  • Phone: 954-257-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-453495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: