Healthcare Provider Details

I. General information

NPI: 1710280417
Provider Name (Legal Business Name): GEOVANNA TOWERS MS SLP CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2010
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85313 HARTS RD
YULEE FL
32097-3892
US

IV. Provider business mailing address

84622 BALSAM CT
FERNANDINA BEACH FL
32034-0313
US

V. Phone/Fax

Practice location:
  • Phone: 904-468-5124
  • Fax:
Mailing address:
  • Phone: 845-636-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA21759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: