Healthcare Provider Details

I. General information

NPI: 1457894370
Provider Name (Legal Business Name): JOHN PARKER WARD APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12470 TELECOM DR STE 300
TEMPLE TERRACE FL
33637-0904
US

IV. Provider business mailing address

12470 TELECOM DR STE 300
TEMPLE TERRACE FL
33637-0904
US

V. Phone/Fax

Practice location:
  • Phone: 813-871-8200
  • Fax: 813-357-5501
Mailing address:
  • Phone: 813-871-8200
  • Fax: 813-357-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704325406
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020112
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9486534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: