Provider Demographics
NPI:1467198465
Name:TOMBERLIN, TAYLOR DIANE (RBT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DIANE
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-3608
Mailing Address - Country:US
Mailing Address - Phone:524-242-5973
Mailing Address - Fax:
Practice Address - Street 1:5848 8TH ST
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-3608
Practice Address - Country:US
Practice Address - Phone:352-424-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-214839106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT516-804-99-742-0OtherDRIVER'S LICENSE