Provider Demographics
NPI:1326094525
Name:TOMICH, JOANN (CRNA)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:TOMICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 SW CAPTAINS PL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1746
Mailing Address - Country:US
Mailing Address - Phone:772-283-8588
Mailing Address - Fax:
Practice Address - Street 1:1756 SW CAPTAINS PL
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1746
Practice Address - Country:US
Practice Address - Phone:772-283-8588
Practice Address - Fax:772-283-8588
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP890032171W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302091600Medicaid
FLG0263Medicare ID - Type Unspecified
FL302091600Medicaid