Provider Demographics
NPI:1497443048
Name:CHIUSANO, JOELLEN (APRN)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:CHIUSANO
Suffix:
Gender:F
Credentials:APRN
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 191
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-0191
Mailing Address - Country:US
Mailing Address - Phone:941-448-9895
Mailing Address - Fax:
Practice Address - Street 1:6310 HEALTH PARK WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-907-8951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner