Provider Demographics
NPI:1104605971
Name:FLOWERS, DERRESA (RBT)
Entity type:Individual
Prefix:
First Name:DERRESA
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 LANDON PRESERVE CIR APT 6303
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5033
Mailing Address - Country:US
Mailing Address - Phone:402-317-7803
Mailing Address - Fax:
Practice Address - Street 1:4015 CRESCENT PARK DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3605
Practice Address - Country:US
Practice Address - Phone:813-219-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL297853106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician