Provider Demographics
NPI:1417307075
Name:NUBIN, JASMINE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:NUBIN
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 1:17134 GATHERING PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8596
Mailing Address - Country:US
Mailing Address - Phone:407-456-1849
Mailing Address - Fax:
Practice Address - Street 1:3200 S HIAWASSEE RD SUITE 203
Practice Address - Street 2:ROOM 1317
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1817
Practice Address - Country:US
Practice Address - Phone:321-972-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 247200000X
FL21-164102106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other