Provider Demographics
NPI:1962056325
Name:NIEVES, JOSHUA ISAAC (RBT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ISAAC
Last Name:NIEVES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10302 BIRDWATCH DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2905
Mailing Address - Country:US
Mailing Address - Phone:813-909-3909
Mailing Address - Fax:
Practice Address - Street 1:8270 WOODLAND CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2401
Practice Address - Country:US
Practice Address - Phone:813-417-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-59401106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0211332200Medicaid