Healthcare Provider Details

I. General information

NPI: 1992612501
Provider Name (Legal Business Name): MARISSA LAUREN CAMPBELL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 MARINER BLVD
SPRING HILL FL
34609-5625
US

IV. Provider business mailing address

8302 SKY EAGLE DR
TAMPA FL
33635-8001
US

V. Phone/Fax

Practice location:
  • Phone: 352-684-6722
  • Fax:
Mailing address:
  • Phone: 727-741-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY3007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: