Provider Demographics
NPI:1740799469
Name:SEVERINO, FRANK
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:SEVERINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 HODGES BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5279
Mailing Address - Country:US
Mailing Address - Phone:604-516-4149
Mailing Address - Fax:604-516-4150
Practice Address - Street 1:2108 PARK AVE STE 108
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5589
Practice Address - Country:US
Practice Address - Phone:904-375-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5249237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist