Provider Demographics
NPI:1023308277
Name:FRANK, JANE FITZGERALD
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:FITZGERALD
Last Name:FRANK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:FITZGERALD
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2112 W SOUTHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3106
Mailing Address - Country:US
Mailing Address - Phone:813-810-7927
Mailing Address - Fax:
Practice Address - Street 1:2112 W SOUTHVIEW AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3106
Practice Address - Country:US
Practice Address - Phone:813-810-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist