Provider Demographics
NPI:1659404671
Name:FAULL, ROSANN W (DOCTOR OF AUDIOLOGY)
Entity Type:Individual
Prefix:DR
First Name:ROSANN
Middle Name:W
Last Name:FAULL
Suffix:
Gender:F
Credentials:DOCTOR OF AUDIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 496231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ000AOtherBLUECROSS/BLUESHIELD
FL6005314Medicaid
FLJ000AOtherBLUECROSS/BLUESHIELD