Provider Demographics
NPI:1730449604
Name:VERGE, JOSEPH WARREN (ANP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WARREN
Last Name:VERGE
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2128
Mailing Address - Country:US
Mailing Address - Phone:727-345-7100
Mailing Address - Fax:727-345-7102
Practice Address - Street 1:630 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2128
Practice Address - Country:US
Practice Address - Phone:727-345-7100
Practice Address - Fax:727-345-7102
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304318-1363LA2200X
FLARNP9415612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLMVR5OtherFLORIDA BLUE
FL018482700Medicaid
FLLMVR5OtherFLORIDA BLUE