MEDICARE: DIANA WARNCKE AUD

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	231H00000X	Audiologist	SLP-AU-LIC-11721	MT
2	231H00000X	Audiologist	DA10086	AZ
3	237600000X	Audiologist-Hearing Aid Fitter
4	231H00000X	Audiologist	AY2932	FL

General Provider Information

NPI Number	:	1720430291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA WARNCKE AUD

Provider Business Mailing Address
First Line	:	5960 BEACH BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5113
Country	:	US
Telephone Number	:	904-399-3323
Fax Number	:	904-399-3360

Provider Business Practice Location Address
First Line	:	5960 BEACH BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5113
Country	:	US
Telephone Number	:	904-399-3323
Fax Number	:	904-399-3360

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

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	11/12/2025

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