Provider Demographics
NPI:1235620394
Name:JOSEPHS, GLENFORD (COO)
Entity Type:Individual
Prefix:
First Name:GLENFORD
Middle Name:
Last Name:JOSEPHS
Suffix:
Gender:M
Credentials:COO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13150 N 20TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3206
Mailing Address - Country:US
Mailing Address - Phone:813-504-4188
Mailing Address - Fax:
Practice Address - Street 1:13150 N 20TH ST APT 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3206
Practice Address - Country:US
Practice Address - Phone:813-504-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA345984376K00000X, 251E00000X
FLCNA-345984251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty