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General NPI Number Information
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NPI Number | 1053142927
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Entity Type | Individual
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Provider Name | DERIVIA WINN
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Gender | Female
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 4015 CRESCENT PARK DR
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City | RIVERVIEW
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State | FL
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Zip | 33578-3605
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Country | US
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Telephone | 813-492-8310
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Fax |
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Provider Business Mailing Address
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Address Line | 7636 E SHORE DR
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City | INVERNESS
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State | FL
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Zip | 34450-5088
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Country | US
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Telephone | 706-351-0574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-368696
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License Number State | GA
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