Provider Demographics
NPI:1891543823
Name:BANKS, ABIGAIL ROSANNA (HIGH SCHOOL DIPLOMA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ROSANNA
Last Name:BANKS
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 PUNTA GORDA DR
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4611
Mailing Address - Country:US
Mailing Address - Phone:407-726-7307
Mailing Address - Fax:
Practice Address - Street 1:1444 PUNTA GORDA DR
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-4611
Practice Address - Country:US
Practice Address - Phone:407-726-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-343469106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician