Provider Demographics
NPI:1154001717
Name:STROM, NATHAN BRADLEY (AUD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:BRADLEY
Last Name:STROM
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 BELFORT RD STE 340
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1409
Mailing Address - Country:US
Mailing Address - Phone:904-880-0911
Mailing Address - Fax:904-888-9388
Practice Address - Street 1:4203 BELFORT RD STE 340
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1409
Practice Address - Country:US
Practice Address - Phone:904-880-0911
Practice Address - Fax:904-888-9388
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2750231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist