Healthcare Provider Details

I. General information

NPI: 1083765762
Provider Name (Legal Business Name): THOMAS JEFFREY TRAYNHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 US HIGHWAY 98 N
LAKELAND FL
33809-3603
US

IV. Provider business mailing address

3745 WILLOW WISP DR N
LAKELAND FL
33810-4474
US

V. Phone/Fax

Practice location:
  • Phone: 863-853-5452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS 2399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: