Healthcare Provider Details

I. General information

NPI: 1326089772
Provider Name (Legal Business Name): JOSEPH HIBBARD CRNA, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MALABAR RD NE
PALM BAY FL
32907-2506
US

IV. Provider business mailing address

PO BOX 561600
ROCKLEDGE FL
32956-1600
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-8025
  • Fax: 321-434-8075
Mailing address:
  • Phone: 321-434-4600
  • Fax: 321-259-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number039730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: