Provider Demographics
NPI:1609553544
Name:JOANNA PARADISO LLC
Entity Type:Organization
Organization Name:JOANNA PARADISO LLC
Other - Org Name:PARADISO AMOFA & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADISO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:404-916-6420
Mailing Address - Street 1:900 WOODBRIDGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1324
Mailing Address - Country:US
Mailing Address - Phone:404-916-6420
Mailing Address - Fax:
Practice Address - Street 1:900 WOODBRIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1324
Practice Address - Country:US
Practice Address - Phone:404-916-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1033754783Medicaid