Healthcare Provider Details

I. General information

NPI: 1306275797
Provider Name (Legal Business Name): JENNIFER THOMAS AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N DAVIS HWY STE A
PENSACOLA FL
32503-2344
US

IV. Provider business mailing address

4900 N DAVIS HWY STE A
PENSACOLA FL
32503-2344
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-0700
  • Fax: 850-476-4300
Mailing address:
  • Phone: 850-476-0700
  • Fax: 850-476-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1136A
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 2010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: