MEDICARE: JESSICA NEGLIA

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
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst	1-20-44047	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033657614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA NEGLIA

Provider Business Mailing Address
First Line	:	1202 TECH BLVD STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7863
Country	:	US
Telephone Number	:	813-438-6796
Fax Number	:	813-252-1367

Provider Business Practice Location Address
First Line	:	1202 TECH BLVD STE 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7863
Country	:	US
Telephone Number	:	813-438-6796
Fax Number	:	813-252-1367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	04/21/2022

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Directions to “ JESSICA NEGLIA ” Practice Location

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