Individual
MR. PHILLIP MARTIN HERRING II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11258 WINDSOR PLACE CIR, TAMPA, FL 33626-2688
(773) 669-4821
Mailing address
11258 WINDSOR PLACE CIR, TAMPA, FL 33626-2688
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043111308
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578644431
BAY PINES VA HEALTH CARE SYSTEMS
FL
Enumeration date
07/15/2017
Last updated
07/15/2017
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