Healthcare Provider Details

I. General information

NPI: 1629956651
Provider Name (Legal Business Name): N'MYA J PIERCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MITAD CIR
ST AUGUSTINE FL
32095-7445
US

IV. Provider business mailing address

32 MITAD CIR
ST AUGUSTINE FL
32095-7445
US

V. Phone/Fax

Practice location:
  • Phone: 904-747-2903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-377244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: