Healthcare Provider Details

I. General information

NPI: 1013637578
Provider Name (Legal Business Name): JONATHAN HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S HOOVER BLVD STE 202
TAMPA FL
33609-3574
US

IV. Provider business mailing address

205 S HOOVER BLVD STE 202
TAMPA FL
33609-3574
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-1155
  • Fax: 813-602-0216
Mailing address:
  • Phone: 813-563-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: