Provider Demographics
NPI:1457886517
Name:TABLIZO, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:TABLIZO
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 1:625 EGRET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-1712
Mailing Address - Country:US
Mailing Address - Phone:407-574-0697
Mailing Address - Fax:
Practice Address - Street 1:6903 SAWTOOTH CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-8451
Practice Address - Country:US
Practice Address - Phone:321-236-7619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-46885103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst