Healthcare Provider Details

I. General information

NPI: 1053670406
Provider Name (Legal Business Name): JENNA ANNE RALPH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST SUITE 204
MIAMI FL
33125-1673
US

IV. Provider business mailing address

699 CHURCH ST NE STE 340
MARIETTA GA
30060-1131
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-0090
  • Fax: 305-325-0082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1688
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: