=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528906575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEREDITH DANAE HALL
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2026
-----------------------------------------------------
Last Update Date | 03/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 W VERNE ST STE A
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-2320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-321-4658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6276 SILVER LEAF LN
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33813-2932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-899-8512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW19613
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------