Healthcare Provider Details

I. General information

NPI: 1780310581
Provider Name (Legal Business Name): LOGAN PIMENTEL SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6936 MEDICAL VIEW LN
ZEPHYRHILLS FL
33542-6602
US

IV. Provider business mailing address

1136 OLD WINDSOR WAY
SPRING HILL FL
34609-4654
US

V. Phone/Fax

Practice location:
  • Phone: 352-232-8997
  • Fax:
Mailing address:
  • Phone: 352-467-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75460
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: