Provider Demographics
NPI:1639760143
Name:PAULK, JANNA
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:PAULK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8998 W LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-7229
Mailing Address - Country:US
Mailing Address - Phone:850-207-7064
Mailing Address - Fax:
Practice Address - Street 1:6041 SW 54TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5521
Practice Address - Country:US
Practice Address - Phone:352-877-2161
Practice Address - Fax:352-877-2083
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011149363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care