Provider Demographics
NPI:1962945550
Name:FIRST COAST MOBILE AUDIOLOGY, LLC
Entity type:Organization
Organization Name:FIRST COAST MOBILE AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:904-982-4833
Mailing Address - Street 1:1065 MEADOW VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1055
Mailing Address - Country:US
Mailing Address - Phone:904-982-4833
Mailing Address - Fax:
Practice Address - Street 1:1065 MEADOW VIEW LN
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1055
Practice Address - Country:US
Practice Address - Phone:904-982-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1214332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment