Provider Demographics
NPI:1598412645
Name:PINNER, TABITHA J
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:J
Last Name:PINNER
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 1:2150 N BAYSHORE DR APT 1909
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5465
Mailing Address - Country:US
Mailing Address - Phone:850-797-8497
Mailing Address - Fax:
Practice Address - Street 1:2150 N BAYSHORE DR APT 1909
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5465
Practice Address - Country:US
Practice Address - Phone:850-797-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-23-64541103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110369400Medicaid