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General NPI Number Information
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NPI Number | 1821647157
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Entity Type | Individual
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Provider Name | JASMINE NICOLE POOLE MS
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 2202 MANDARIN LOOP
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City | DUNDEE
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State | FL
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Zip | 33838-4387
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Country | US
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Telephone | 833-869-2423
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Fax | 863-869-6727
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Provider Business Mailing Address
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Address Line | 584 JETT LN
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City | DAVENPORT
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State | FL
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Zip | 33837-8645
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Country | US
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Telephone | 813-900-1917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | FL
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