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General NPI Number Information
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NPI Number | 1972134807
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Entity Type | Individual
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Provider Name | EVANGELINE MARIE HERBERT
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Gender | Female
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 14700 TAMIAMI TRL N STE 1
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City | NAPLES
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State | FL
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Zip | 34110-6221
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Country | US
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Telephone | 239-212-0024
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Fax |
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Provider Business Mailing Address
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Address Line | 300 INTERNATIONAL PKWY STE 200
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City | LAKE MARY
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State | FL
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Zip | 32746-3625
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Country | US
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Telephone | 866-610-0580
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-73898
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License Number State | FL
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