Healthcare Provider Details

I. General information

NPI: 1063329951
Provider Name (Legal Business Name): ELIZABETH BARBOSA AGUDELO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 MINGO DR
LAND O LAKES FL
34638-7247
US

IV. Provider business mailing address

2816 MINGO DR
LAND O LAKES FL
34638-7247
US

V. Phone/Fax

Practice location:
  • Phone: 813-497-0148
  • Fax:
Mailing address:
  • Phone: 813-497-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2837069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: