MEDICARE: GERIANNE DAVENPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	AS2574	FL

General Provider Information

NPI Number	:	1205188562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERIANNE DAVENPORT

Provider Business Mailing Address
First Line	:	3210 WATERMAN WAY
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5243
Country	:	US
Telephone Number	:	352-343-4488
Fax Number	:	352-343-7722

Provider Business Practice Location Address
First Line	:	235 CITRUS TOWER BLVD STE 106
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-2711
Country	:	US
Telephone Number	:	352-243-1212
Fax Number	:	352-243-6474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	02/02/2014

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