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Individual

ERNISHA M SISTRUNK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCABA

Contact information

Practice address
6816 SOUTHPOINT PKWY STE 202, JACKSONVILLE, FL 32216-1701
(904) 419-7792
Mailing address
5717 ORTEGA PARK BLVD, JACKSONVILLE, FL 32244-4525
(904) 554-7818

Taxonomy

Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-19-10172
FL

Other

Enumeration date
10/09/2019
Last updated
10/09/2019
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