Healthcare Provider Details

I. General information

NPI: 1184093262
Provider Name (Legal Business Name): ATLANTIC AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 S NOVA RD STE B1
PORT ORANGE FL
32127-4244
US

IV. Provider business mailing address

3840 S NOVA RD STE B1
PORT ORANGE FL
32127-4244
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-8225
  • Fax: 386-767-0742
Mailing address:
  • Phone: 386-756-8225
  • Fax: 386-767-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: FORREST CADE SIMPSON
Title or Position: OWNER
Credential:
Phone: 936-776-7028