Provider Demographics
NPI:1326510546
Name:COLINA, KARLA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:COLINA
Suffix:
Gender:
Credentials:
Other - Prefix:MRS
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:10905 N EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5106
Mailing Address - Country:US
Mailing Address - Phone:813-841-4229
Mailing Address - Fax:
Practice Address - Street 1:10905 N EDISON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5106
Practice Address - Country:US
Practice Address - Phone:813-841-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-25-15900106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNAMedicaid