Healthcare Provider Details

I. General information

NPI: 1023313509
Provider Name (Legal Business Name): GREATER TAMPA HEARING AIDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13902 N. DALE MABRY HIGHWAY SUITE 106
TAMPA FL
33618
US

IV. Provider business mailing address

2835 W. DELEON ST SUITE 202
TAMPA FL
33609
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-2685
  • Fax: 813-876-5872
Mailing address:
  • Phone: 813-877-2685
  • Fax: 813-876-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY CLARK
Title or Position: OWNER
Credential: AUD,CCC-A
Phone: 813-969-1477