Healthcare Provider Details

I. General information

NPI: 1346569860
Provider Name (Legal Business Name): JUDITH ANN CICALE CCC-A, F-AAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 43RD STREET SUITE 1
GAINESVILLE FL
32607-2557
US

IV. Provider business mailing address

500 NW 43RD STREET SUITE 1
GAINESVILLE FL
32607-2557
US

V. Phone/Fax

Practice location:
  • Phone: 352-271-5373
  • Fax: 352-271-5393
Mailing address:
  • Phone: 352-271-5373
  • Fax: 352-271-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: