Most Relevant Information
Provider Data
| NPI Number: | 1003479726 |
| Provider Name: | NICHOLE BASHARA RBT19-80867 |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | 19-80867 |
Most Important Dates
| Enumeration Date: | 04/18/2019 |
| Last Updated: | 08/30/2024 |
Provider Practice Location
8382 BAYMEADOWS RD
JACKSONVILLE
FL
322564447
Practice Location Phone/Fax
| Phone: | 9044667186 |
| Fax: |
Provider Mailing Location
1264 NIPIGON AVE S
JACKSONVILLE
FL
322332226
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |