Provider Demographics
NPI:1093694259
Name:PETERSON, JADA RHENI
Entity type:Individual
Prefix:MISS
First Name:JADA
Middle Name:RHENI
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 CREEKBEND DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2351
Mailing Address - Country:US
Mailing Address - Phone:813-812-1722
Mailing Address - Fax:
Practice Address - Street 1:1538 CREEKBEND DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2351
Practice Address - Country:US
Practice Address - Phone:813-812-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician