Healthcare Provider Details

I. General information

NPI: 1801589841
Provider Name (Legal Business Name): ROBYN GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4432 TALON LOOP UNIT 105
LAKELAND FL
33812-6407
US

IV. Provider business mailing address

454 W PIPKIN RD
LAKELAND FL
33813-2545
US

V. Phone/Fax

Practice location:
  • Phone: 813-774-1866
  • Fax:
Mailing address:
  • Phone: 863-619-2809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: