Healthcare Provider Details

I. General information

NPI: 1063322261
Provider Name (Legal Business Name): TESSA JOY METCALF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COLOR PL STE 101
APOPKA FL
32703-7717
US

IV. Provider business mailing address

1197 TALLOW RD
APOPKA FL
32703-8442
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 888-754-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2837096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: