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General NPI Number Information
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NPI Number | 1598623332
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Entity Type | Individual
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Provider Name | SAMUEL JAMES TANZ RBT
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Gender | Male
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 1650 DAVIS DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-5933
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Country | US
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Telephone | 321-961-7831
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Fax |
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Provider Business Mailing Address
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Address Line | 4839 CHASTAIN DR
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City | MELBOURNE
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State | FL
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Zip | 32940-1277
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Country | US
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Telephone | 321-507-7785
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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 | BACB1450305
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License Number State | FL
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