Provider Demographics
NPI:1346441862
Name:RUNKLE, JOANNA R (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:R
Last Name:RUNKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-4195
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:400 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5722
Practice Address - Country:US
Practice Address - Phone:407-581-9180
Practice Address - Fax:407-926-9173
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100734207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0003774 00Medicaid
FL68430OtherBCBS
P00677586OtherRAILROAD MEDICARE
FL68430OtherBCBS