Provider Demographics
NPI:1568628899
Name:HERBERT, JANICE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:M
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 76074
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33734-6074
Mailing Address - Country:US
Mailing Address - Phone:727-786-0850
Mailing Address - Fax:
Practice Address - Street 1:1012 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4006
Practice Address - Country:US
Practice Address - Phone:727-786-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042935207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055056600Medicaid
10D0911949OtherCLIA
FL055056600Medicaid
10D0911949OtherCLIA