Provider Demographics
NPI:1467513168
Name:PONCE, JOSELYN CABALO FUNTANILLA (APRN-RX)
Entity Type:Individual
Prefix:MS
First Name:JOSELYN
Middle Name:CABALO FUNTANILLA
Last Name:PONCE
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-5759
Mailing Address - Fax:808-433-2203
Practice Address - Street 1:1 JARRETT WHITE RD BLDG 4
Practice Address - Street 2:
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859
Practice Address - Country:US
Practice Address - Phone:808-433-5759
Practice Address - Fax:808-433-2203
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-795363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI33OtherUHA
HI0000253732OtherHMSA
HI568066Medicaid
HI100671Medicare ID - Type Unspecified
HI0000253732OtherHMSA