Healthcare Provider Details

I. General information

NPI: 1033846605
Provider Name (Legal Business Name): YVETTE SAMARA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 LAKELAND HIGHLANDS RD
LAKELAND FL
33803-4338
US

IV. Provider business mailing address

7302 WILLOW PARK DR
TAMPA FL
33637-6462
US

V. Phone/Fax

Practice location:
  • Phone: 863-686-3189
  • Fax: 863-686-3189
Mailing address:
  • Phone: 813-449-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: