Provider Demographics
NPI:1508087263
Name:COOK-STOBAUGH, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:COOK-STOBAUGH
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 1:310 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7008
Mailing Address - Country:US
Mailing Address - Phone:386-402-8777
Mailing Address - Fax:386-402-8185
Practice Address - Street 1:2290 S VOLUSIA AVE
Practice Address - Street 2:STE A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7649
Practice Address - Country:US
Practice Address - Phone:386-218-4909
Practice Address - Fax:386-218-4911
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLAS4182237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist