Provider Demographics
NPI:1629082433
Name:PENANSKY, BJ WALPER (CNM ARNP)
Entity Type:Individual
Prefix:MRS
First Name:BJ
Middle Name:WALPER
Last Name:PENANSKY
Suffix:
Gender:F
Credentials:CNM ARNP
Other - Prefix:MRS
Other - First Name:B J
Other - Middle Name:KRONE
Other - Last Name:PENANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM ARNP
Mailing Address - Street 1:1012 HALLWOOD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7718
Mailing Address - Country:US
Mailing Address - Phone:813-245-0913
Mailing Address - Fax:
Practice Address - Street 1:1012 HALLWOOD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7718
Practice Address - Country:US
Practice Address - Phone:813-245-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1302962367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
E6786ZMedicare ID - Type Unspecified
P57224Medicare UPIN