Provider Demographics
NPI:1710856489
Name:MERCADO-OLAVARRIA, JASMIN
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:MERCADO-OLAVARRIA
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 1:8731 LAKE MARION CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-8350
Mailing Address - Country:US
Mailing Address - Phone:407-669-6678
Mailing Address - Fax:
Practice Address - Street 1:8731 LAKE MARION CREEK RD
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-8350
Practice Address - Country:US
Practice Address - Phone:407-669-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician