Jaclyn Blaquiere

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-24-73004 Issued in FL

Practice address

28410 Bonita Xing Blvd Unit 150
Bonita Springs, FL 34135-3217

Phone

(239) 451-7163

NPI assigned

Jul 12, 2021

Last updated

Dec 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1679145544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 CRAYTON RD",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341032442",
            "telephone_number": "304-685-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28410 BONITA XING BLVD UNIT 150",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341353217",
            "telephone_number": "239-451-7163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAQUIERE",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-24-73004",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliana Maria Betzios, DMD
• John Joseph Bialorucki, PT, DPT
• Bio-Medical Applications of Florida, Inc. (Bonita Springs Artificial Kidney Center)
• Kaitlyn L Black, M.A. CCC-SLP
• Katherine Blaga
• Ida D Blount, M.S.; LMFT
• Bmuc Holdings Inc
• Body Pain Medical Center, Inc.
• David R Boerkoel, OTR
• Guillermo Bohm, MD

• Behavior Analyst in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.