Healthcare Provider Details

I. General information

NPI: 1063345643
Provider Name (Legal Business Name): WINNIE NABUKENYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 SEMINOLE DR
FORT PIERCE FL
34982-7648
US

IV. Provider business mailing address

124 SW PEACOCK BLVD APT 201
PORT SAINT LUCIE FL
34986-3484
US

V. Phone/Fax

Practice location:
  • Phone: 772-216-2501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-525667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: