Healthcare Provider Details

I. General information

NPI: 1184361719
Provider Name (Legal Business Name): MS. HEIDI JOSWIG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 5TH AVE N
ST PETERSBURG FL
33713-7521
US

IV. Provider business mailing address

301 17TH AVE NE
ST PETERSBURG FL
33704-3502
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2273
  • Fax:
Mailing address:
  • Phone: 727-266-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: