Provider Demographics
NPI:1720489131
Name:IGLESIA, JAZZMYN (MS BCBA)
Entity Type:Individual
Prefix:
First Name:JAZZMYN
Middle Name:
Last Name:IGLESIA
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 STONE GLEN WAY APT 107
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1784
Mailing Address - Country:US
Mailing Address - Phone:407-780-0177
Mailing Address - Fax:
Practice Address - Street 1:2911 STONE GLEN WAY APT 107
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1784
Practice Address - Country:US
Practice Address - Phone:407-780-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
FL1-15-20590103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other