Provider Demographics
NPI:1861885576
Name:BRAVO, JARENICE
Entity type:Individual
Prefix:
First Name:JARENICE
Middle Name:
Last Name:BRAVO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 FOUNTAIN COIN LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5001
Mailing Address - Country:US
Mailing Address - Phone:407-501-0834
Mailing Address - Fax:
Practice Address - Street 1:1052 FOUNTAIN COIN LOOP FL 32828
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-5001
Practice Address - Country:US
Practice Address - Phone:407-501-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician