Provider Demographics
NPI:1750044111
Name:ZIMMERMAN, CORNETA MAE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:CORNETA
Middle Name:MAE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:NETA
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4891 GLOVER LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4556
Mailing Address - Country:US
Mailing Address - Phone:850-626-0606
Mailing Address - Fax:850-361-3443
Practice Address - Street 1:4891 GLOVER LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4556
Practice Address - Country:US
Practice Address - Phone:850-626-0606
Practice Address - Fax:850-361-3443
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-189778106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician