Healthcare Provider Details

I. General information

NPI: 1780639187
Provider Name (Legal Business Name): BETTINA SANDERS TUCKER AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 E FOWLER AVE COMMUNICATION SCIENCES AND DISORDERS-PCD 1017
TAMPA FL
33620-8001
US

IV. Provider business mailing address

4202 E FOWLER AVE COMMUNICATION SCIENCES AND DISORDERS-PCD 1017
TAMPA FL
33620-8001
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-8804
  • Fax: 813-974-0822
Mailing address:
  • Phone: 813-974-8804
  • Fax: 813-974-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY425
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: