Provider Demographics
NPI:1821179649
Name:JOSEPH D HOWARD
Entity type:Organization
Organization Name:JOSEPH D HOWARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-916-1636
Mailing Address - Street 1:1354 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3471
Mailing Address - Country:US
Mailing Address - Phone:850-916-1636
Mailing Address - Fax:850-916-1350
Practice Address - Street 1:1354 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3471
Practice Address - Country:US
Practice Address - Phone:850-916-1636
Practice Address - Fax:850-916-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1704722363L00000X
FL1034362363LF0000X
FLME33582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260551100Medicaid
FLK2375Medicare PIN