Healthcare Provider Details

I. General information

NPI: 1073238333
Provider Name (Legal Business Name): ALYSSA HOFHEINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 S BUMBY AVE
ORLANDO FL
32806-8704
US

IV. Provider business mailing address

758 FOREST ST
WINTER SPRINGS FL
32708-2109
US

V. Phone/Fax

Practice location:
  • Phone: 407-800-7711
  • Fax:
Mailing address:
  • Phone: 205-790-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-222817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: