Provider Demographics
NPI:1417611393
Name:NUNEZ, JEREBELLE (RBT)
Entity Type:Individual
Prefix:
First Name:JEREBELLE
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 MEMORIAL HWY STE A7
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4503
Mailing Address - Country:US
Mailing Address - Phone:786-442-6916
Mailing Address - Fax:
Practice Address - Street 1:6105 MEMORIAL HWY STE A7
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4503
Practice Address - Country:US
Practice Address - Phone:786-442-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-186433106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician