MEDICARE: FLORIDA PSYCHOEDUCATIONAL EVALUATIONS

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1932724291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PSYCHOEDUCATIONAL EVALUATIONS

Provider Business Mailing Address
First Line	:	10144 ARBOR RUN DR UNIT 128
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3570
Country	:	US
Telephone Number	:	813-384-8481
Fax Number	:

Provider Business Practice Location Address
First Line	:	10144 ARBOR RUN DR UNIT 128
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3570
Country	:	US
Telephone Number	:	813-384-8481
Fax Number	:

Authorized Official
Title or Position	:	LICENSED SCHOOL PSYCHOLOGIST
Name	:	STACY LAUREN ZEBRICK
Credential	:	EDS
Telephone Number	:	813-384-8481

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	06/12/2020

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