Provider Demographics
NPI:1194188797
Name:WESLEY, JOANNA (NP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WESLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 MERLIN CT
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6753
Mailing Address - Country:US
Mailing Address - Phone:850-783-0279
Mailing Address - Fax:850-826-9051
Practice Address - Street 1:304 MERLIN CT
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6753
Practice Address - Country:US
Practice Address - Phone:850-783-0279
Practice Address - Fax:850-826-9051
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226798363LF0000X
FLAPRN11014991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily