Provider Demographics
NPI:1740694439
Name:MIZELLE, ROBYN K
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:K
Last Name:MIZELLE
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 1:12276 SAN JOSE BLVD. GREAT STRIDES REHABILITATION
Mailing Address - Street 2:SUITE 507
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-886-3228
Mailing Address - Fax:
Practice Address - Street 1:12276 SAN JOSE BLVD. GREAT STRIDES REHABILITATION
Practice Address - Street 2:SUITE 507
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-886-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst