Healthcare Provider Details

I. General information

NPI: 1750504718
Provider Name (Legal Business Name): FIRST COAST HEARING CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CYPRESS POINT PKWY SUITE B3
PALM COAST FL
32164-2500
US

IV. Provider business mailing address

50 CYPRESS POINT PKWY SUITE B3
PALM COAST FL
32164-2500
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-7364
  • Fax: 386-447-8742
Mailing address:
  • Phone: 386-447-7364
  • Fax: 386-447-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY689
License Number StateFL

VIII. Authorized Official

Name: MELANEE BRYANS
Title or Position: OFFICE MANAGER
Credential:
Phone: 386-447-7364