Provider Demographics
NPI:1790495158
Name:BOU, JASMINE NICHOLE
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:NICHOLE
Last Name:BOU
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 1:7420 THUNDERHEAD ST
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33544-2600
Mailing Address - Country:US
Mailing Address - Phone:813-943-5930
Mailing Address - Fax:
Practice Address - Street 1:2389 OAK MYRTLE LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6328
Practice Address - Country:US
Practice Address - Phone:813-862-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician