Provider Demographics
NPI:1346242708
Name:MIDDLETON, JOANNE P (CNM, NP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:P
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BEACH 129 ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-486-7374
Mailing Address - Fax:718-486-6927
Practice Address - Street 1:119 BEACH 129 ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694
Practice Address - Country:US
Practice Address - Phone:718-486-7374
Practice Address - Fax:718-486-6927
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000385176B00000X
NYF360200-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00810980Medicaid
NY00810980Medicaid