Provider Demographics
NPI:1013545664
Name:COOK, JOHANNA YADIRA
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:YADIRA
Last Name:COOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 W QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3842
Mailing Address - Country:US
Mailing Address - Phone:757-232-2644
Mailing Address - Fax:
Practice Address - Street 1:ORLANDO HEALTH ORLANDO REGIONAL MEDICAL CENTER
Practice Address - Street 2:52 W. UNDERWOOD ST
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:321-841-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001224821163WS0200X
FLAPRN11008593367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool