Provider Demographics
NPI:1083217129
Name:HAMILTON, JEREMY (HAS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13223 RAMBLEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4043
Mailing Address - Country:US
Mailing Address - Phone:406-594-1286
Mailing Address - Fax:
Practice Address - Street 1:2221A TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2104
Practice Address - Country:US
Practice Address - Phone:941-625-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5324237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist