Provider Demographics
NPI:1629054648
Name:CELENZA, JOANNE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:M
Last Name:CELENZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11970 N CENTRAL EXPY STE 520
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3768
Mailing Address - Country:US
Mailing Address - Phone:972-566-4866
Mailing Address - Fax:972-566-2469
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE A307
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-4866
Practice Address - Fax:972-566-2469
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002198363AS0400X
TXAP08625363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010222796Medicaid
203639329OtherTRICARE PROVIDER NUMBER
203639329OtherTRICARE PROVIDER NUMBER