Healthcare Provider Details

I. General information

NPI: 1720489131
Provider Name (Legal Business Name): JAZZMYN MIJIC M.S. BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 STONE GLEN WAY APT 107
WINTER PARK FL
32792-1784
US

IV. Provider business mailing address

2911 STONE GLEN WAY APT 107
WINTER PARK FL
32792-1784
US

V. Phone/Fax

Practice location:
  • Phone: 407-780-0177
  • Fax:
Mailing address:
  • Phone: 407-780-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-20590
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: