Provider Demographics
NPI:1184409674
Name:HIBBARD, JOEL A
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:HIBBARD
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 1:609 6TH WAY # 609
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6672
Mailing Address - Country:US
Mailing Address - Phone:910-515-1505
Mailing Address - Fax:
Practice Address - Street 1:609 6TH WAY # 609
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6672
Practice Address - Country:US
Practice Address - Phone:910-515-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program