Provider Demographics
NPI:1669340295
Name:JUBERT, NATASHA DOMINIQUE (BS)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:DOMINIQUE
Last Name:JUBERT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 PICNIC CT
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-2815
Mailing Address - Country:US
Mailing Address - Phone:407-620-9442
Mailing Address - Fax:
Practice Address - Street 1:3309 PICNIC CT
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:FL
Practice Address - Zip Code:33920-2815
Practice Address - Country:US
Practice Address - Phone:407-620-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst