=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396480174
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA NIETO LENES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2022
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11983 TAMIAMI TRL N # 121
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-1603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-875-1871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11715 18TH PL E UNIT 214
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34211-5065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-504-9690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 22-231651
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------