MEDICARE: HARRIET JOECKEL

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	156FX1800X	Optician	DO4620	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	:	1902408370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIET JOECKEL

Provider Business Mailing Address
First Line	:	4359 35TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33714-3717
Country	:	US
Telephone Number	:	727-914-8615
Fax Number	:	727-914-8610

Provider Business Practice Location Address
First Line	:	10041 US HIGHWAY 19 STE A
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3785
Country	:	US
Telephone Number	:	727-868-0780
Fax Number	:	727-857-4365

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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Directions to “ HARRIET JOECKEL ” Practice Location

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