Healthcare Provider Details

I. General information

NPI: 1073427068
Provider Name (Legal Business Name): MADELINE MARIE ARNOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CRESCENT PARK DR
RIVERVIEW FL
33578-3605
US

IV. Provider business mailing address

6916 115TH ST E
PALMETTO FL
34221-1399
US

V. Phone/Fax

Practice location:
  • Phone: 813-492-8310
  • Fax:
Mailing address:
  • Phone: 309-756-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: