Provider Demographics
NPI:1346019890
Name:PERKINS, JASON ROBERT
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SANIBEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33956-2231
Mailing Address - Country:US
Mailing Address - Phone:239-246-8979
Mailing Address - Fax:
Practice Address - Street 1:12493 BRANTLEY COMMONS CT FL 33907
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5693
Practice Address - Country:US
Practice Address - Phone:239-268-8707
Practice Address - Fax:239-567-5878
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-317701106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician