MEDICARE: AMY WILDE

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	AS3315	FL

General Provider Information

NPI Number	:	1801227277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY WILDE

Provider Business Mailing Address
First Line	:	7373 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4300
Country	:	US
Telephone Number	:	352-688-0648
Fax Number	:	352-688-4801

Provider Business Practice Location Address
First Line	:	7373 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4300
Country	:	US
Telephone Number	:	352-688-0648
Fax Number	:	352-688-4801

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

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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