Healthcare Provider Details

I. General information

NPI: 1417464538
Provider Name (Legal Business Name): STAVERMAN HEARING CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 SAN JOSE BLVD STE 710
JACKSONVILLE FL
32223-8674
US

IV. Provider business mailing address

204 LAGUNA VILLA BLVD UNIT A16
JACKSONVILLE BEACH FL
32250-8007
US

V. Phone/Fax

Practice location:
  • Phone: 904-262-5550
  • Fax:
Mailing address:
  • Phone: 904-305-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE STAVERMAN
Title or Position: AUDIOLOGIST / OWNER
Credential: AUD
Phone: 904-262-5550