Provider Demographics
NPI:1386974707
Name:DR. ROSANN W. FAULL LLC
Entity type:Organization
Organization Name:DR. ROSANN W. FAULL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FAULL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:904-262-5550
Mailing Address - Street 1:12276 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8628
Mailing Address - Country:US
Mailing Address - Phone:904-262-5550
Mailing Address - Fax:904-683-4592
Practice Address - Street 1:12276 SAN JOSE BLVD
Practice Address - Street 2:SUITE 710
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8628
Practice Address - Country:US
Practice Address - Phone:904-262-5550
Practice Address - Fax:904-683-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 496237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ000AOtherBLUECROSS/BLUESHIELD