Basic Information
| Provider Information | |||||||||
| NPI: | 1528521267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THORSEN | ||||||||
| FirstName: | DARREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 PRESERVATION WAY | ||||||||
| Address2: | |||||||||
| City: | OLDSMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346774824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072567449 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6962 22ND AVE N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337103920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273813277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2019 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS3638 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.