Healthcare Provider Details

I. General information

NPI: 1588487169
Provider Name (Legal Business Name): HANNA TUZOVA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 NAVAHO DR STE 150
RALEIGH NC
27609-7377
US

IV. Provider business mailing address

1325 LEGACY GREENE AVE
WAKE FOREST NC
27587-4344
US

V. Phone/Fax

Practice location:
  • Phone: 919-438-3438
  • Fax: 984-370-6535
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2689
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: