Provider Demographics
NPI:1295594125
Name:HIATT, ROSS WAYNE (HIS)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:WAYNE
Last Name:HIATT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2530
Mailing Address - Country:US
Mailing Address - Phone:813-788-7833
Mailing Address - Fax:
Practice Address - Street 1:6239 FORT KING RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2530
Practice Address - Country:US
Practice Address - Phone:813-788-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5797237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist