Provider Demographics
NPI:1104655653
Name:EILAND, ISABELLA NICOLE
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:NICOLE
Last Name:EILAND
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 1:1531 W LEMON ST APT 2410
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1039
Mailing Address - Country:US
Mailing Address - Phone:407-551-9107
Mailing Address - Fax:
Practice Address - Street 1:1531 W LEMON ST APT 2410
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1039
Practice Address - Country:US
Practice Address - Phone:407-551-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPF-1719357980-25666106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician