Provider Demographics
NPI:1275174427
Name:TAVERNIER, JERMAINE QUEEN (BA)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:QUEEN
Last Name:TAVERNIER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 LAKE ATRIUMS CIR APT 29
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2127
Mailing Address - Country:US
Mailing Address - Phone:340-277-7735
Mailing Address - Fax:
Practice Address - Street 1:1916 LAKE ATRIUMS CIR APT 29
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2127
Practice Address - Country:US
Practice Address - Phone:340-277-7735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator