Provider Demographics
NPI:1083263859
Name:PARKER, PRISCILLA ELIZABETH (RBT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ELIZABETH
Last Name:PARKER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:ELIZABETH
Other - Last Name:TROOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2195 CABOOSE LN APT 401
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3695
Mailing Address - Country:US
Mailing Address - Phone:352-274-1049
Mailing Address - Fax:
Practice Address - Street 1:8001 BEATY GROVE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1602
Practice Address - Country:US
Practice Address - Phone:813-926-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician