Provider Demographics
NPI:1578135489
Name:DR. JOONIES EXAMINAVAN
Entity Type:Organization
Organization Name:DR. JOONIES EXAMINAVAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:SHANTELLE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-551-3399
Mailing Address - Street 1:400 N ASHLEY DR STE 1900
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4311
Mailing Address - Country:US
Mailing Address - Phone:813-551-3399
Mailing Address - Fax:
Practice Address - Street 1:400 N ASHLEY DR STE 1900
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4311
Practice Address - Country:US
Practice Address - Phone:813-551-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100212600Medicaid