Healthcare Provider Details

I. General information

NPI: 1508404211
Provider Name (Legal Business Name): HIDDEN POTENTIAL FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2857 SOUTH BUMBY AVENUE
ORLANDO FL
32806
US

IV. Provider business mailing address

PO BOX 844
WINTER PARK FL
32790
US

V. Phone/Fax

Practice location:
  • Phone: 407-800-7711
  • Fax: 407-317-6571
Mailing address:
  • Phone: 407-800-7711
  • Fax: 407-317-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L BLAIR
Title or Position: OWNER
Credential: BCBA
Phone: 407-800-7711