Provider Demographics
NPI:1821643099
Name:JOSEPH, JEROME N (CERTIFIED)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:N
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1460
Mailing Address - Country:US
Mailing Address - Phone:239-491-4700
Mailing Address - Fax:877-836-4662
Practice Address - Street 1:3108 6TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1460
Practice Address - Country:US
Practice Address - Phone:239-491-4700
Practice Address - Fax:877-836-4662
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
FL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXXXOtherACE