Healthcare Provider Details

I. General information

NPI: 1821179649
Provider Name (Legal Business Name): JOSEPH D HOWARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 COUNTRY CLUB RD
GULF BREEZE FL
32563-3471
US

IV. Provider business mailing address

1354 COUNTRY CLUB RD
GULF BREEZE FL
32563-3471
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-1636
  • Fax: 850-916-1350
Mailing address:
  • Phone: 850-916-1636
  • Fax: 850-916-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME33582
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1704722
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1034362
License Number StateFL

VIII. Authorized Official

Name: MRS. MARILYN K HOWARD
Title or Position: MANAGER
Credential: ARNP
Phone: 850-916-1636