Provider Demographics
NPI:1427890946
Name:OSORIO, THAINA (BACB962971)
Entity type:Individual
Prefix:MRS
First Name:THAINA
Middle Name:
Last Name:OSORIO
Suffix:
Gender:F
Credentials:BACB962971
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TURKEY LAKE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4205
Mailing Address - Country:US
Mailing Address - Phone:321-732-3723
Mailing Address - Fax:321-352-7168
Practice Address - Street 1:3242 MURRAY HILL LOOP
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-2851
Practice Address - Country:US
Practice Address - Phone:407-860-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB962971106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician