MEDICARE: ISHMEAL A HIBBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BACB636261	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225627797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHMEAL A HIBBERT

Provider Business Mailing Address
First Line	:	4620 N STATE ROAD 7 STE 300
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4343 ANCHOR PLAZA PKWY STE 150
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7532
Country	:	US
Telephone Number	:	813-787-2215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	12/17/2025

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Directions to “ ISHMEAL A HIBBERT ” Practice Location

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