Provider Demographics
NPI:1699469221
Name:PALACIO, NORKIS
Entity type:Individual
Prefix:
First Name:NORKIS
Middle Name:
Last Name:PALACIO
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 1:14059 RIVEREDGE DR UNIT 6211
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1047
Mailing Address - Country:US
Mailing Address - Phone:813-703-4107
Mailing Address - Fax:
Practice Address - Street 1:14059 RIVEREDGE DR UNIT 6211
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-1047
Practice Address - Country:US
Practice Address - Phone:813-703-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst