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NPI Code Detail

MEDICARE: MISS NICHOLE BASHARA RBT19-80867

MEDICARE: MISS NICHOLE BASHARA RBT19-80867
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician19-80867FL

General Provider Information

NPI Number : 1003479726
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS NICHOLE BASHARA RBT19-80867
Provider Business Mailing Address
First Line : 1264 NIPIGON AVE S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32233-2226
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8382 BAYMEADOWS RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4447
Country : US
Telephone Number : 904-466-7186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2019
Last Update Date : 08/30/2024

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