Individual
JOHNATHAN ERIC FOURTHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 E JACKSON ST, STE 2340, TAMPA, FL 33602-5233
(813) 841-5032
Mailing address
401 E JACKSON ST, STE 2340, TAMPA, FL 33602-5233
(813) 841-5032
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
03/11/2014
Last updated
03/11/2014
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