Provider Demographics
NPI:1205188562
Name:DAVENPORT, GERIANNE
Entity Type:Individual
Prefix:
First Name:GERIANNE
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5243
Mailing Address - Country:US
Mailing Address - Phone:352-343-4488
Mailing Address - Fax:352-343-7722
Practice Address - Street 1:235 CITRUS TOWER BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2711
Practice Address - Country:US
Practice Address - Phone:352-243-1212
Practice Address - Fax:352-243-6474
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2574237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist