Provider Demographics
NPI:1336515931
Name:J C HALL ARNP PA
Entity Type:Organization
Organization Name:J C HALL ARNP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOELLA
Authorized Official - Middle Name:CAULEY
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:386-793-6628
Mailing Address - Street 1:3760 PEAR AVE
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-4887
Mailing Address - Country:US
Mailing Address - Phone:386-793-6628
Mailing Address - Fax:386-437-5912
Practice Address - Street 1:3760 PEAR AVE
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-4887
Practice Address - Country:US
Practice Address - Phone:386-793-6628
Practice Address - Fax:386-437-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9216912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty