Healthcare Provider Details

I. General information

NPI: 1760125694
Provider Name (Legal Business Name): KATIA VIGNATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 PRIMROSE LAKE CIR
TAMPA FL
33647-3589
US

IV. Provider business mailing address

2035 SW 75TH ST STE B
GAINESVILLE FL
32607-3425
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax: 352-332-8589
Mailing address:
  • Phone: 877-823-4283
  • Fax: 352-332-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15305
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: