Healthcare Provider Details

I. General information

NPI: 1992885495
Provider Name (Legal Business Name): JANICE M HERBERT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 NEBRASKA AVE
PALM HARBOR FL
34683
US

IV. Provider business mailing address

PO BOX 76074
ST PETERSBURG FL
33734-6074
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-0850
  • Fax:
Mailing address:
  • Phone: 727-786-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800010180
License Number StateFL

VIII. Authorized Official

Name: JANICE MARIE HERBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 727-786-0850