Healthcare Provider Details

I. General information

NPI: 1295668358
Provider Name (Legal Business Name): TANICA ELOISA MONTANEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: TANICA ELOISA SANABRIA

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COLGATE DR
ALTAMONTE SPRINGS FL
32714-1306
US

IV. Provider business mailing address

611 COLGATE DR
ALTAMONTE SPRINGS FL
32714-1306
US

V. Phone/Fax

Practice location:
  • Phone: 321-422-8116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: