MEDICARE: HALSTON VICTORIA QUINN N/A

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
2	106S00000X	Behavior Technician		FL

General Provider Information

NPI Number	:	1902686074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALSTON VICTORIA QUINN N/A

Provider Business Mailing Address
First Line	:	10318 GOLDENBROOK WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2929
Country	:	US
Telephone Number	:	813-526-6427
Fax Number	:

Provider Business Practice Location Address
First Line	:	10318 GOLDENBROOK WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2929
Country	:	US
Telephone Number	:	813-526-6427
Fax Number	:

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

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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Directions to “ HALSTON VICTORIA QUINN N/A” Practice Location

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