Provider Demographics
NPI:1023435567
Name:GAVIN, LISA FAITH
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:FAITH
Last Name:GAVIN
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 1:5 TAMPA GENERAL CIR
Mailing Address - Street 2:SUITE 610
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3601
Mailing Address - Country:US
Mailing Address - Phone:813-315-4327
Mailing Address - Fax:813-315-4329
Practice Address - Street 1:5 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE 610
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3601
Practice Address - Country:US
Practice Address - Phone:813-315-4327
Practice Address - Fax:813-315-4329
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAZ668231H00000X
FLAY1862231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist