Provider Demographics
NPI:1285332718
Name:YUAN, JIAYIN JEANNE
Entity type:Individual
Prefix:
First Name:JIAYIN
Middle Name:JEANNE
Last Name:YUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27845 MANOR OAK DR # 11207
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5368
Mailing Address - Country:US
Mailing Address - Phone:774-402-9236
Mailing Address - Fax:
Practice Address - Street 1:3109 W DR MARTIN LUTHER KING JR BLVD STE 500
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6220
Practice Address - Country:US
Practice Address - Phone:813-289-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-23-257894OtherBEHAVIOR THERAPIST