Healthcare Provider Details

I. General information

NPI: 1558014613
Provider Name (Legal Business Name): ANA IDALIA SANTIAGO FONSECA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 N FLORIDA AVE SUITE D-1458
TAMPA FL
33604-6007
US

IV. Provider business mailing address

6421 N FLORIDA AVE SUITE D-1458
TAMPA FL
33604-6007
US

V. Phone/Fax

Practice location:
  • Phone: 813-305-2867
  • Fax:
Mailing address:
  • Phone: 855-832-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14646
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71148
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-188546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: