Provider Demographics
NPI:1023683539
Name:BRAZLE, ZARIA PRESHA (RBT)
Entity type:Individual
Prefix:
First Name:ZARIA
Middle Name:PRESHA
Last Name:BRAZLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1831 GOLDEN EAGLE WAY STE 34-35
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4339
Mailing Address - Country:US
Mailing Address - Phone:904-579-4779
Mailing Address - Fax:888-501-3580
Practice Address - Street 1:1831 GOLDEN EAGLE WAY STE 34-35
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4339
Practice Address - Country:US
Practice Address - Phone:904-579-4779
Practice Address - Fax:888-501-3580
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician