Healthcare Provider Details

I. General information

NPI: 1306244801
Provider Name (Legal Business Name): SIMPLYABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1765 SW CAPTAINS PL
PALM CITY FL
34990-1747
US

IV. Provider business mailing address

1765 SW CAPTAINS PL
PALM CITY FL
34990-1747
US

V. Phone/Fax

Practice location:
  • Phone: 772-266-8727
  • Fax: 772-494-7093
Mailing address:
  • Phone: 772-266-8727
  • Fax: 772-494-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1031181
License Number StateFL

VIII. Authorized Official

Name: BRENDA LINER
Title or Position: OFFICE MANAGER
Credential:
Phone: 772-266-8727