MEDICARE: ETHAN JOSEPH SKOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	RBT-26-511893	FL

General Provider Information

NPI Number	:	1164372520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN JOSEPH SKOL

Provider Business Mailing Address
First Line	:	8412 N CHEVALIER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-7604
Country	:	US
Telephone Number	:	773-892-5587
Fax Number	:

Provider Business Practice Location Address
First Line	:	8412 N CHEVALIER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-7604
Country	:	US
Telephone Number	:	773-892-5587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ ETHAN JOSEPH SKOL ” Practice Location

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