Provider Demographics
NPI:1497468243
Name:TRIPLETT, JOASHA JOASHA
Entity Type:Individual
Prefix:
First Name:JOASHA
Middle Name:JOASHA
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILLISA
Other - Middle Name:J L
Other - Last Name:TRIPLETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2913 MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5417
Mailing Address - Country:US
Mailing Address - Phone:850-656-7484
Mailing Address - Fax:
Practice Address - Street 1:2913 MAHAN DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5417
Practice Address - Country:US
Practice Address - Phone:850-656-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103663183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician