Healthcare Provider Details

I. General information

NPI: 1407651284
Provider Name (Legal Business Name): KARLIE ANN SPENCER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HALAPA WAY
TRINITY FL
34655-7229
US

IV. Provider business mailing address

1250 HALAPA WAY
TRINITY FL
34655-7229
US

V. Phone/Fax

Practice location:
  • Phone: 727-686-4190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA23780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: