Provider Demographics
NPI:1366884009
Name:HERT, ANA P (BCABA)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:P
Last Name:HERT
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 SAN JOSE PL
Mailing Address - Street 2:STE. 22
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2436
Mailing Address - Country:US
Mailing Address - Phone:904-928-0112
Mailing Address - Fax:904-928-0112
Practice Address - Street 1:3771 SAN JOSE PL
Practice Address - Street 2:STE. 22
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2436
Practice Address - Country:US
Practice Address - Phone:904-928-0112
Practice Address - Fax:904-928-0112
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-11-4176103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst