Provider Demographics
NPI:1598400509
Name:DORTA HERNANDEZ, YANET
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:DORTA HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10206 TURTLE HILL CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1636
Mailing Address - Country:US
Mailing Address - Phone:813-382-5863
Mailing Address - Fax:
Practice Address - Street 1:10206 TURTLE HILL CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1636
Practice Address - Country:US
Practice Address - Phone:813-382-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-210944106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-22-210944OtherBACB - BEHAVIOR ANALYST CERTIFICATION BOARD