Provider Demographics
NPI:1508117391
Name:LOO, JANET A (ARNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:LOO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 9TH AVE N
Mailing Address - Street 2:STE 110
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7146
Mailing Address - Country:US
Mailing Address - Phone:727-820-7778
Mailing Address - Fax:727-820-7779
Practice Address - Street 1:2191 9TH AVE N
Practice Address - Street 2:STE 110
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7146
Practice Address - Country:US
Practice Address - Phone:727-820-7778
Practice Address - Fax:727-820-7779
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9346876363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGO043YOtherWELLMED PTAN