Provider Demographics
NPI:1205842572
Name:DUNLAP, JANICE JEAN (APRN-BC, CNS)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:JEAN
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:APRN-BC, CNS
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:JEAN
Other - Last Name:DYKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-BC, CNS
Mailing Address - Street 1:1106 HOSPITAL ROAD
Mailing Address - Street 2:NEUROSCIENCE CENTER
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-8273
Mailing Address - Fax:850-863-7045
Practice Address - Street 1:1106 HOSPITAL ROAD
Practice Address - Street 2:NEUROSCIENCE CENTER
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8273
Practice Address - Fax:850-863-7045
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9253950363LA2200X
IL209-005121364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007201000Medicaid
FLY0F1ZOtherBCBSFL
FL007201000Medicaid