Healthcare Provider Details

I. General information

NPI: 1629448998
Provider Name (Legal Business Name): XAVIER POTTER AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HENDERSON BLVD STE 600
TAMPA FL
33629-5032
US

IV. Provider business mailing address

3825 HENDERSON BLVD STE 600
TAMPA FL
33629-5032
US

V. Phone/Fax

Practice location:
  • Phone: 813-751-2263
  • Fax: 813-588-6463
Mailing address:
  • Phone: 813-751-2263
  • Fax: 813-588-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2813
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number11652
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY2813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: