Healthcare Provider Details

I. General information

NPI: 1861136616
Provider Name (Legal Business Name): CHRISTINA TIERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 LAKE ELLENOR DR
ORLANDO FL
32809-4633
US

IV. Provider business mailing address

221 WALTON HEATH DR
ORLANDO FL
32828-8015
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone: 901-570-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: