Healthcare Provider Details

I. General information

NPI: 1760839724
Provider Name (Legal Business Name): ROBERT FOSTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5447 E BEAUMONT CENTER BLVD
TAMPA FL
33634-5210
US

IV. Provider business mailing address

766 SILVER CLOUD CIR APT 106
LAKE MARY FL
32746-1526
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 813-245-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-10329
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45656
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: