Provider Demographics
NPI:1174250799
Name:WEAVER, JASON JAROD
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JAROD
Last Name:WEAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-6915
Mailing Address - Country:US
Mailing Address - Phone:305-748-8382
Mailing Address - Fax:
Practice Address - Street 1:560 VILLAGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1963
Practice Address - Country:US
Practice Address - Phone:561-515-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician