Provider Demographics
NPI: | 1023017217 |
---|---|
Name: | WERNICKI, JOANNE WOJICK (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOANNE |
Middle Name: | WOJICK |
Last Name: | WERNICKI |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1485 37TH ST |
Mailing Address - Street 2: | SUITE 107 |
Mailing Address - City: | VERO BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32960-6500 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 772-569-9745 |
Mailing Address - Fax: | 772-567-6868 |
Practice Address - Street 1: | 1485 37TH ST |
Practice Address - Street 2: | SUITE 107 |
Practice Address - City: | VERO BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32960-6500 |
Practice Address - Country: | US |
Practice Address - Phone: | 772-569-9745 |
Practice Address - Fax: | 772-567-6868 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-19 |
Last Update Date: | 2022-08-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME0057399 | 2085B0100X, 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 052809900 | Medicaid | |
FL | 052809900 | Medicaid | |
FL | 11557X | Medicare PIN |