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Individual

MS. AMY C TYNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA CCC SLP

Contact information

Practice address
3020 LAKELAND HIGHLANDS RD, LAKELAND, FL 33803-4338
(863) 686-3189
(863) 682-1348
Mailing address
3020 LAKELAND HIGHLANDS RD, LAKELAND, FL 33803-4338
(863) 686-3189
(863) 682-1348

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA3653
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
113991
AMERIGROUP
FL
01
11982201
CITRUS HEALTHCARE
FL
01
244
ATA
FL
01
672202496
MEDWAIVER
FL
05
883059200
FL
01
S2869
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/10/2006
Last updated
06/20/2016
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