Provider Demographics
NPI:1114409091
Name:JOSEPHS, CAROL J (RN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:JOSEPHS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6132
Mailing Address - Country:US
Mailing Address - Phone:813-810-6257
Mailing Address - Fax:866-666-2451
Practice Address - Street 1:815 BRYAN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6132
Practice Address - Country:US
Practice Address - Phone:813-810-6257
Practice Address - Fax:866-666-2451
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL678549296261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities