Healthcare Provider Details

I. General information

NPI: 1538941265
Provider Name (Legal Business Name): EMILY ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NW 76TH DR
GAINESVILLE FL
32607-6668
US

IV. Provider business mailing address

250 NW 76TH DR
GAINESVILLE FL
32607-6668
US

V. Phone/Fax

Practice location:
  • Phone: 525-056-3633
  • Fax: 352-505-6383
Mailing address:
  • Phone: 525-056-3633
  • Fax: 352-505-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-258351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: