Provider Demographics
NPI:1295087229
Name:WARD, NIZAMMAH S (MS)
Entity type:Individual
Prefix:
First Name:NIZAMMAH
Middle Name:S
Last Name:WARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 DR M L K JR ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-2829
Mailing Address - Country:US
Mailing Address - Phone:727-455-2511
Mailing Address - Fax:
Practice Address - Street 1:3530 1ST AVE N STE 205
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8442
Practice Address - Country:US
Practice Address - Phone:727-351-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL13850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health