Healthcare Provider Details

I. General information

NPI: 1003222977
Provider Name (Legal Business Name): JACOB EDWARD TONNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JACOB TONNA M. ED BCBA # 1-21-52

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 OLD HIGHWAY 41 S SUITE 119
MOUNT DORA FL
32757
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 352-358-5001
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52065
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52065
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52065
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: