Individual
JUDITH A TIBERIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
3191 HARBOR BLVD STE A, SUITE A, PORT CHARLOTTE, FL 33952-6755
(941) 766-9555
(941) 766-1511
Mailing address
3191 HARBOR BLVD STE A, PORT CHARLOTTE, FL 33952-6755
(941) 766-9555
(941) 766-1511
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN2927142
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300323000
—
FL
01
—
Y7196
BCBS
FL
Enumeration date
09/20/2005
Last updated
06/06/2019
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