Healthcare Provider Details

I. General information

NPI: 1356264162
Provider Name (Legal Business Name): ALYSSA PACKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19213 SEA MIST LN
LUTZ FL
33558-9714
US

IV. Provider business mailing address

19213 SEA MIST LN
LUTZ FL
33558-9714
US

V. Phone/Fax

Practice location:
  • Phone: 813-943-4428
  • Fax:
Mailing address:
  • Phone: 813-943-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: