1699758383 NPI number — JENNIFER REEVES LABORDE AUDIOLOGIST

Table of content: JENNIFER REEVES LABORDE AUDIOLOGIST (NPI 1699758383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699758383 NPI number — JENNIFER REEVES LABORDE AUDIOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LABORDE
Provider First Name:
JENNIFER
Provider Middle Name:
REEVES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUDIOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REEVES
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUDIOLOGY
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699758383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8333 N DAVIS HWY
Provider Second Line Business Mailing Address:
MEDICAL CENTER CLINIC AUDIOLOGY DEPT
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32514-6050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-474-8328
Provider Business Mailing Address Fax Number:
850-474-8791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8333 N DAVIS HWY
Provider Second Line Business Practice Location Address:
WEST FLORIDA MEDICAL CENTER CLINIC PA
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32514-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-474-8328
Provider Business Practice Location Address Fax Number:
850-474-8791
Provider Enumeration Date:
11/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AY001064 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016560900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".