MEDICARE: TAMPA BAY ABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1013871623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY ABA LLC

Provider Business Mailing Address
First Line	:	10559 DUSTY BOOT RD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-3068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10559 DUSTY BOOT RD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-3068
Country	:	US
Telephone Number	:	813-452-7790
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NELISA CONCEPCION GOMEZ
Credential	:	BCBA
Telephone Number	:	813-452-7790

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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