Provider Demographics
NPI:1083097661
Name:TOBON, ANDREA (MS BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:TOBON
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 SE COUNTY HIGHWAY 484
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-8621
Mailing Address - Country:US
Mailing Address - Phone:352-233-7465
Mailing Address - Fax:
Practice Address - Street 1:4611 SE 100TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3013
Practice Address - Country:US
Practice Address - Phone:352-559-2539
Practice Address - Fax:352-547-5787
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst