Provider Demographics
NPI:1366583072
Name:TOMLINSON, AMY FAITH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:FAITH
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2692 SE COUNTY ROAD 21B
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-5112
Mailing Address - Country:US
Mailing Address - Phone:352-745-2752
Mailing Address - Fax:352-335-1575
Practice Address - Street 1:250 NW 76TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6668
Practice Address - Country:US
Practice Address - Phone:352-745-2752
Practice Address - Fax:352-505-6383
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887603700Medicaid
FLS2400OtherBLUE CROSS & BLUE SHIELD