MEDICARE: JENNIFER LYNN MIDDLEBROOKS HID

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	237600000X	Audiologist-Hearing Aid Fitter	80885	TX

General Provider Information

NPI Number	:	1669088985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN MIDDLEBROOKS HID

Provider Business Mailing Address
First Line	:	4625 BOAT CLUB RD STE 257
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7023
Country	:	US
Telephone Number	:	817-346-6464
Fax Number	:	817-238-0054

Provider Business Practice Location Address
First Line	:	4625 BOAT CLUB RD STE 257
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7023
Country	:	US
Telephone Number	:	817-346-6464
Fax Number	:	817-238-0054

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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