Individual
JOSHUA HACKENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
777 N ASHLEY DR UNIT 2007, TAMPA, FL 33602-4375
(570) 490-7195
Mailing address
777 N ASHLEY DR UNIT 2007, TAMPA, FL 33602-4375
(570) 490-7195
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9112319
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
PA9112319
FL
Other
Enumeration date
07/29/2019
Last updated
05/03/2022
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