Provider Demographics
NPI:1184071094
Name:NENNI, TAMARA (BCBA)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:NENNI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CITRUS CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-3702
Mailing Address - Country:US
Mailing Address - Phone:727-744-9829
Mailing Address - Fax:
Practice Address - Street 1:90 CITRUS CT
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-3702
Practice Address - Country:US
Practice Address - Phone:727-744-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1000169103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011132200OtherMEDICAID WAIVER