Healthcare Provider Details

I. General information

NPI: 1841995651
Provider Name (Legal Business Name): GLORIA MARIE KOBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5447 E BEAUMONT CENTER BLVD
TAMPA FL
33634-5210
US

IV. Provider business mailing address

16924 NIKKI LN
ODESSA FL
33556-6014
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 412-980-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: