Healthcare Provider Details

I. General information

NPI: 1346078698
Provider Name (Legal Business Name): EVA FORNARIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4793 N CONGRESS AVE STE 203
BOYNTON BEACH FL
33426-7937
US

IV. Provider business mailing address

2692 BAHIA RD
WEST PALM BEACH FL
33406-7756
US

V. Phone/Fax

Practice location:
  • Phone: 561-722-9107
  • Fax:
Mailing address:
  • Phone: 561-932-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-363148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: