Healthcare Provider Details

I. General information

NPI: 1770427007
Provider Name (Legal Business Name): EVERGREEN TREE ABA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W FL-40 SUITE 100 OFFICE 26
OCALA FL
34482
US

IV. Provider business mailing address

5100 W FL-40 SUITE 100 OFFICE 26
OCALA FL
34482
US

V. Phone/Fax

Practice location:
  • Phone: 954-812-5912
  • Fax:
Mailing address:
  • Phone: 954-812-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: NATALIA FONSECA
Title or Position: OWNER
Credential:
Phone: 954-812-1305