Active NPI
Tracy Oxendine, M.ED. CCC-SLP
- Speech-Language Pathologist
- Leesburg, FL
National Provider Identifier
1104565217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA9088
- Practice address
- 606 S 9TH St
Leesburg, FL 34748-6320 - Phone
- (352) 805-4404
- NPI assigned
- May 27, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA9088 | FL | Primary |
Addresses
Primary practice location
606 S 9TH St
Leesburg, FL 34748-6320
Mailing address
PO Box 725
Bushnell, FL 33513-0047
Phone (229) 424-3530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA9088 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653609600000",
"number": "1104565217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 725",
"city": "BUSHNELL",
"state": "FL",
"postal_code": "335130047",
"telephone_number": "229-424-3530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 S 9TH ST",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347486320",
"telephone_number": "352-805-4404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OXENDINE",
"first_name": "TRACY",
"credential": "M.ED. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-27",
"last_updated": "2022-05-27",
"certification_date": "2022-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA9088",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.