Healthcare Provider Details

I. General information

NPI: 1437826724
Provider Name (Legal Business Name): LIFELINE AUDIOLOGY & HEARING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8553 ARGYLE BUSINESS LOOP STE D
JACKSONVILLE FL
32244-6669
US

IV. Provider business mailing address

8553 ARGYLE BUSINESS LOOP STE D
JACKSONVILLE FL
32244-6669
US

V. Phone/Fax

Practice location:
  • Phone: 904-479-5198
  • Fax: 904-417-7012
Mailing address:
  • Phone: 904-479-5198
  • Fax: 904-417-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDENIE AGATHE RAPHAEL
Title or Position: DOCTOR OF AUDIOLOGY
Credential: AU.D
Phone: 407-668-9253