Jacqueline Medina Lage, RBT
Behavior Technician in Tampa, FL. Individual provider (NPI-1).
NPI number1689368656
StatusActive
Last updated in NPPESJun 5, 2023
Details
- NPI
- 1689368656
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Medina Lage
- Credential
- RBT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 5, 2023
- Certification date
- May 30, 2023
- Last updated
- Jun 5, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | 23-275532 | FL | Yes |
Practice location
7117 Robindale RdTampa, FL 33619-4723
Phone 813-550-7293
Mailing address
7117 Robindale RdTampa, FL 33619-4723
Phone 813-550-7293
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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