Provider Demographics
NPI:1780639187
Name:TUCKER, BETTINA SANDERS (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:SANDERS
Last Name:TUCKER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 E FOWLER AVE
Mailing Address - Street 2:COMMUNICATION SCIENCES AND DISORDERS-PCD 1017
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33620-8001
Mailing Address - Country:US
Mailing Address - Phone:813-974-8804
Mailing Address - Fax:813-974-0822
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:COMMUNICATION SCIENCES AND DISORDERS-PCD 1017
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-8001
Practice Address - Country:US
Practice Address - Phone:813-974-8804
Practice Address - Fax:813-974-0822
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY425231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS006SOtherBLUE CROSS BLUE SHIELD
FL006642800Medicaid
FL006642801Medicaid
FL006642800Medicaid