Provider Demographics
NPI:1891126181
Name:HIBBERTS, STEVEN MICHAEL (AP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:HIBBERTS
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 ISABELLA BLVD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8003
Mailing Address - Country:US
Mailing Address - Phone:912-507-9605
Mailing Address - Fax:
Practice Address - Street 1:2850 ISABELLA BLVD
Practice Address - Street 2:SUITE 50
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8003
Practice Address - Country:US
Practice Address - Phone:912-507-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3240171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist