Provider Demographics
NPI:1124642574
Name:DARST, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:DARST
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 1:2035 SW 75TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-3425
Mailing Address - Country:US
Mailing Address - Phone:877-823-4283
Mailing Address - Fax:352-332-8589
Practice Address - Street 1:5330 PRIMROSE LAKE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3589
Practice Address - Country:US
Practice Address - Phone:877-823-4283
Practice Address - Fax:352-332-8589
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL0-23-14510106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst