Healthcare Provider Details

I. General information

NPI: 1780338475
Provider Name (Legal Business Name): TAYLOR A CEPERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E PINE ST
LAKELAND FL
33801-4969
US

IV. Provider business mailing address

PO BOX 6553
LAKELAND FL
33807-6553
US

V. Phone/Fax

Practice location:
  • Phone: 863-602-0698
  • Fax: 813-354-2715
Mailing address:
  • Phone: 863-602-0698
  • Fax: 813-354-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78093
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-200161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: