Provider Demographics
NPI:1508319963
Name:BRYANT, JAZMINE ETIENNE
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:ETIENNE
Last Name:BRYANT
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 1:1102 S MISSOURI AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-9131
Mailing Address - Country:US
Mailing Address - Phone:727-831-8873
Mailing Address - Fax:
Practice Address - Street 1:1102 S MISSOURI AVE APT 107
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-9131
Practice Address - Country:US
Practice Address - Phone:727-831-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-22-14152106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst