Provider Demographics
NPI:1558029496
Name:MULLANEY, JOANNE (RN)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:MULLANEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MARVIN JONES RD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-4521
Mailing Address - Country:US
Mailing Address - Phone:512-629-7562
Mailing Address - Fax:
Practice Address - Street 1:129 MARVIN JONES RD
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-4521
Practice Address - Country:US
Practice Address - Phone:512-629-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3211082156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist