Individual
NICOLE IBANEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1590 TROPIC PARK DR, SANFORD, FL 32773-6323
(407) 202-2220
(407) 369-4307
Mailing address
121 N HIGHLAND ST, MOUNT DORA, FL 32757-5764
(352) 720-5194
(407) 386-7133
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/12/2020
Last updated
09/13/2022
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