Healthcare Provider Details

I. General information

NPI: 1255080370
Provider Name (Legal Business Name): TIFFANY SOSSA-DIAZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 CAMPANIA WAY UNIT 311
NAPLES FL
34104-6694
US

IV. Provider business mailing address

7533 CAMPANIA WAY UNIT 311
NAPLES FL
34104-6694
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-9186
  • Fax:
Mailing address:
  • Phone: 813-397-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-200524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: