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NPI Code Detail

MEDICARE: TIYANAH MIXSON

MEDICARE: TIYANAH MIXSON
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 TechnicianFL

General Provider Information

NPI Number : 1942152798
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIYANAH MIXSON
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 : 866-610-1558
Fax Number : 866-611-1558
Provider Business Practice Location Address
First Line : 45 ALABAMA AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-2677
Country : US
Telephone Number : 904-420-2304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2026
Last Update Date : 02/13/2026

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Directions to “ TIYANAH MIXSON ” Practice Location

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