Provider Demographics
NPI:1083360911
Name:STRIBLING, MARK ALAN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:STRIBLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13405 NE 203RD TER
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:FL
Mailing Address - Zip Code:32694-4418
Mailing Address - Country:US
Mailing Address - Phone:904-600-7366
Mailing Address - Fax:
Practice Address - Street 1:13405 NE 203RD TER
Practice Address - Street 2:
Practice Address - City:WALDO
Practice Address - State:FL
Practice Address - Zip Code:32694-4418
Practice Address - Country:US
Practice Address - Phone:904-600-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT14437227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered