=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487171377
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE CARDONA AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2017
-----------------------------------------------------
Last Update Date | 10/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10475 CENTURION PARKWAY, N SUITE 303
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-399-0350
-----------------------------------------------------
Fax | 904-399-5914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11945 SAN JOSE BLVD SUITE 300
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32223-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-396-1725
-----------------------------------------------------
Fax | 904-396-4893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AY2142
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AUD004145
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------