=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396362257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANNER ANDERSON MS, BCBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2020
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11476 S APOPKA VINELAND RD STE 118
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-7006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-955-4001
-----------------------------------------------------
Fax | 407-745-0738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 INTERNATIONAL PKWY STE 200
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-915-7729
-----------------------------------------------------
Fax | 407-588-6294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-20-125841
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-21-53342
-----------------------------------------------------
License Number State |
-----------------------------------------------------