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NPI Code Detail

MEDICARE: TANNER ANDERSON MS, BCBA

MEDICARE: TANNER ANDERSON MS, BCBA
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
1106S00000XBehavior TechnicianRBT-20-125841FL
2103K00000XBehavior Analyst1-21-53342

Other Identifiers

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

General Provider Information

NPI Number : 1396362257
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANNER ANDERSON MS, BCBA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 407-915-7729
Fax Number : 407-588-6294
Provider Business Practice Location Address
First Line : 11476 S APOPKA VINELAND RD STE 118
Second Line :
City : ORLANDO
State : FL
Zip : 32836-7006
Country : US
Telephone Number : 407-955-4001
Fax Number : 407-745-0738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2020
Last Update Date : 02/13/2026

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