Healthcare Provider Details

I. General information

NPI: 1639838709
Provider Name (Legal Business Name): MICHELE VIRGINIA LINDER MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE VANRYSDAM RBT

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12724 GRAN BAY PKWY W STE 410
JACKSONVILLE FL
32258-9486
US

IV. Provider business mailing address

277 SAWMILL LANDING DR
ST AUGUSTINE FL
32086-0388
US

V. Phone/Fax

Practice location:
  • Phone: 904-687-4012
  • Fax:
Mailing address:
  • Phone: 904-687-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80867
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-195646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: