Provider Demographics
NPI:1407874696
Name:TRIBIANO, TIMOTHY N (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:N
Last Name:TRIBIANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BAY DR
Mailing Address - Street 2:BLDG 100, STE 117
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4900
Mailing Address - Country:US
Mailing Address - Phone:727-776-1968
Mailing Address - Fax:727-289-2301
Practice Address - Street 1:2401 W BAY DR
Practice Address - Street 2:BLDG 100 SUITE 117
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4900
Practice Address - Country:US
Practice Address - Phone:727-776-1968
Practice Address - Fax:727-289-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3126OtherBLUE CROSS
FLY3126OtherBLUE CROSS