Provider Demographics
NPI:1558979310
Name:GIAMMARCO, NICHOLAS ALAN (SLPA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALAN
Last Name:GIAMMARCO
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2241
Mailing Address - Country:US
Mailing Address - Phone:172-736-6659
Mailing Address - Fax:
Practice Address - Street 1:2506 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5036
Practice Address - Country:US
Practice Address - Phone:813-391-8398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI32202355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant