MEDICARE: MS. JULIE NICOLE WILEY AU.D.

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	AY923	FL

General Provider Information

NPI Number	:	1790988731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE NICOLE WILEY AU.D.

Provider Business Mailing Address
First Line	:	PO BOX 152198
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33684-2198
Country	:	US
Telephone Number	:	813-293-2384
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 RIDGELINE BLVD STE A
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-9103
Country	:	US
Telephone Number	:	727-942-4005
Fax Number	:

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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