Provider Demographics
NPI:1669675708
Name:NINYA, REBECCA L (MA,CCC-A)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:NINYA
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 HAMPSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1747
Mailing Address - Country:US
Mailing Address - Phone:904-826-1899
Mailing Address - Fax:
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:STE. 323
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5793
Practice Address - Country:US
Practice Address - Phone:904-826-1899
Practice Address - Fax:904-829-2452
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY695237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter