Healthcare Provider Details

I. General information

NPI: 1538529953
Provider Name (Legal Business Name): ERNIESHA MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 WALDEN WOODS DR
PLANT CITY FL
33563-3610
US

IV. Provider business mailing address

8406 RED SPRUCE AVE
RIVERVIEW FL
33578-8994
US

V. Phone/Fax

Practice location:
  • Phone: 813-686-7617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: