Healthcare Provider Details

I. General information

NPI: 1699518894
Provider Name (Legal Business Name): JENNA SORENSEN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SALISBURY RD STE 340
JACKSONVILLE FL
32216-8057
US

IV. Provider business mailing address

4500 SALISBURY RD STE 340
JACKSONVILLE FL
32216-8057
US

V. Phone/Fax

Practice location:
  • Phone: 904-634-8919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number202671
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: