Healthcare Provider Details

I. General information

NPI: 1720317340
Provider Name (Legal Business Name): AUDIOLOGY AND HEARING CENTER OF TAMPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6906 W LINEBAUGH AVE STE 101
TAMPA FL
33625-5830
US

IV. Provider business mailing address

6906 W LINEBAUGH AVE STE 101
TAMPA FL
33625-5830
US

V. Phone/Fax

Practice location:
  • Phone: 813-962-1888
  • Fax:
Mailing address:
  • Phone: 813-962-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1168
License Number StateFL

VIII. Authorized Official

Name: DR. NANCY MANSZE WONG
Title or Position: OWNER
Credential: AU.D.
Phone: 813-920-8777