Healthcare Provider Details

I. General information

NPI: 1619801297
Provider Name (Legal Business Name): HAILEY RENEE VINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 COMMERCE AVE UNIT 9
IMMOKALEE FL
34142-3820
US

IV. Provider business mailing address

1144 HICKOCK LN
IMMOKALEE FL
34142-2103
US

V. Phone/Fax

Practice location:
  • Phone: 239-315-6517
  • Fax: 239-310-2045
Mailing address:
  • Phone: 239-378-6905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-544446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: