Healthcare Provider Details

I. General information

NPI: 1538847454
Provider Name (Legal Business Name): LANE MARQUARDT BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S PARSONS AVE
BRANDON FL
33511-6063
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 941-263-1451
  • Fax:
Mailing address:
  • Phone: 407-915-7729
  • Fax: 407-588-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: