Healthcare Provider Details

I. General information

NPI: 1992460992
Provider Name (Legal Business Name): JASMINE RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 BUDINGER AVE
SAINT CLOUD FL
34769-7203
US

IV. Provider business mailing address

2900 17TH ST STE 2
SAINT CLOUD FL
34769-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-910-2941
  • Fax:
Mailing address:
  • Phone: 321-241-1170
  • Fax: 321-241-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: