Healthcare Provider Details

I. General information

NPI: 1487576120
Provider Name (Legal Business Name): TREVOR TABBACHINO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 MEADOW GROVE TRL
LAKELAND FL
33810-6918
US

IV. Provider business mailing address

5127 MEADOW GROVE TRL
LAKELAND FL
33810-6918
US

V. Phone/Fax

Practice location:
  • Phone: 301-732-3362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: