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NPI Code Detail

MEDICARE: JESSIE RENAUD

MEDICARE: JESSIE RENAUD
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 Technician
2103K00000XBehavior Analyst1-23-63768FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083228407
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSIE RENAUD
Provider Business Mailing Address
First Line : 9425 RICHWOOD LN
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-4430
Country : US
Telephone Number : 239-451-9473
Fax Number :
Provider Business Practice Location Address
First Line : 4940 NORTHDALE BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33624-1075
Country : US
Telephone Number : 813-485-8444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2020
Last Update Date : 01/25/2023

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Directions to “ JESSIE RENAUD ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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