Provider Demographics
NPI:1578858189
Name:WARE, JOANNA TRIPP (CNS, ARNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:TRIPP
Last Name:WARE
Suffix:
Gender:F
Credentials:CNS, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-7400
Mailing Address - Country:US
Mailing Address - Phone:580-304-7067
Mailing Address - Fax:
Practice Address - Street 1:3011 N UNION ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-7400
Practice Address - Country:US
Practice Address - Phone:580-304-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54172364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
12353876OtherCAQH
OK200431120AMedicaid
OKR0054172OtherAPRN