Provider Demographics
NPI:1447074224
Name:SOMERS, JOSEPH L JR
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:SOMERS
Suffix:JR
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 1:405 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5507
Mailing Address - Country:US
Mailing Address - Phone:813-689-0908
Mailing Address - Fax:
Practice Address - Street 1:405 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5507
Practice Address - Country:US
Practice Address - Phone:813-689-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120040300Medicaid