1174884134 NPI number — APPLIED BEHAVIOR APPROACHES OF TAMPA BAY INC

Table of content: MS. ELENA RAQUELITA TAYLOR RN (NPI 1225795735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174884134 NPI number — APPLIED BEHAVIOR APPROACHES OF TAMPA BAY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLIED BEHAVIOR APPROACHES OF TAMPA BAY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174884134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1353 LOTUS PATH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-241-0246
Provider Business Mailing Address Fax Number:
727-240-4720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18946 NORTH DALE MABRY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTZ
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-241-0246
Provider Business Practice Location Address Fax Number:
727-240-4720
Provider Enumeration Date:
06/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DEHAINAUT
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
LANE
Authorized Official Title or Position:
OWNER; BOARD CERTIFIED BEHAVIOR ANA
Authorized Official Telephone Number:
727-241-0246

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 1-09-5814 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017420700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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