Provider Demographics
NPI:1316488992
Name:PANARELLO, JONATHAN (APRN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PANARELLO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 16TH ST # 4NW4546
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1249
Mailing Address - Country:US
Mailing Address - Phone:424-259-9427
Mailing Address - Fax:424-259-6671
Practice Address - Street 1:1250 16TH ST # 4NW4546
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1249
Practice Address - Country:US
Practice Address - Phone:424-259-9427
Practice Address - Fax:424-259-6671
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9455945363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025124900Medicaid