Provider Demographics
NPI:1306023601
Name:WEAVER, JOSHUA N
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:N
Last Name:WEAVER
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:PO BOX 1902
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-1902
Mailing Address - Country:US
Mailing Address - Phone:352-422-5416
Mailing Address - Fax:352-794-3030
Practice Address - Street 1:406 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-3621
Practice Address - Country:US
Practice Address - Phone:352-422-5416
Practice Address - Fax:352-794-3030
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator