Healthcare Provider Details

I. General information

NPI: 1497682280
Provider Name (Legal Business Name): ANDERSON CARTER KIRACOFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15048 14TH ST
DADE CITY FL
33523-2503
US

IV. Provider business mailing address

15048 14TH ST
DADE CITY FL
33523-2503
US

V. Phone/Fax

Practice location:
  • Phone: 352-232-8997
  • Fax: 833-422-0029
Mailing address:
  • Phone: 352-232-8997
  • Fax: 833-422-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-534838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: