Provider Demographics
NPI:1669031993
Name:COLON, YAZMARIE
Entity Type:Individual
Prefix:
First Name:YAZMARIE
Middle Name:
Last Name:COLON
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 1:10252 S US HWY 441
Mailing Address - Street 2:UNIT 3,4,5
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420
Mailing Address - Country:US
Mailing Address - Phone:352-559-2539
Mailing Address - Fax:352-547-5787
Practice Address - Street 1:10252 S US HWY 441
Practice Address - Street 2:UNIT 3,4,5
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420
Practice Address - Country:US
Practice Address - Phone:352-559-2539
Practice Address - Fax:352-547-5787
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician