Healthcare Provider Details

I. General information

NPI: 1437292547
Provider Name (Legal Business Name): LARA JANINE JOYNES-WHIDDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 N 56TH ST
TAMPA FL
33610-7123
US

IV. Provider business mailing address

4612 N 56TH ST
TAMPA FL
33610-7123
US

V. Phone/Fax

Practice location:
  • Phone: 813-246-4899
  • Fax: 813-246-5119
Mailing address:
  • Phone: 813-246-4899
  • Fax: 813-246-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 6747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: