Healthcare Provider Details

I. General information

NPI: 1215855192
Provider Name (Legal Business Name): TONIA LYNN HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
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

1327 S SHANGRI LA DR
DAYTONA BEACH FL
32119-1502
US

V. Phone/Fax

Practice location:
  • Phone: 904-465-2407
  • Fax:
Mailing address:
  • Phone: 386-562-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: