MEDICARE: DR. BETTINA SANDERS TUCKER AU.D., CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AY425	FL
2	237600000X	Audiologist-Hearing Aid Fitter	AY425	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S006S	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780639187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTINA SANDERS TUCKER AU.D., CCC-A

Provider Business Mailing Address
First Line	:	4202 E FOWLER AVE
Second Line	:	COMMUNICATION SCIENCES AND DISORDERS-PCD 1017
City	:	TAMPA
State	:	FL
Zip	:	33620-8001
Country	:	US
Telephone Number	:	813-974-8804
Fax Number	:	813-974-0822

Provider Business Practice Location Address
First Line	:	4202 E FOWLER AVE
Second Line	:	COMMUNICATION SCIENCES AND DISORDERS-PCD 1017
City	:	TAMPA
State	:	FL
Zip	:	33620-8001
Country	:	US
Telephone Number	:	813-974-8804
Fax Number	:	813-974-0822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/22/2013

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Directions to “ DR. BETTINA SANDERS TUCKER AU.D., CCC-A” Practice Location

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