MEDICARE: TATIANNA RIVERA PAGAN

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	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1821959107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANNA RIVERA PAGAN

Provider Business Mailing Address
First Line	:	720 S GLENCRUITEN AVE
Second Line	:
City	:	LAKE ALFRED
State	:	FL
Zip	:	33850-3018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 S GLENCRUITEN AVE
Second Line	:
City	:	LAKE ALFRED
State	:	FL
Zip	:	33850-3018
Country	:	US
Telephone Number	:	863-551-3300
Fax Number	:

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

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	11/18/2025

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Directions to “ TATIANNA RIVERA PAGAN ” Practice Location

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