Healthcare Provider Details

I. General information

NPI: 1174621163
Provider Name (Legal Business Name): LESLIE ANN NEWMEYER M.ED., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 SAN JOSE BLVD SUITE 710
JACKSONVILLE FL
32223-8628
US

IV. Provider business mailing address

12276 SAN JOSE BLVD SUITE 710
JACKSONVILLE FL
32223-8628
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3486
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY1663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: