Provider Demographics
NPI:1649203233
Name:BUNCE, JANELLE C (PA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:C
Last Name:BUNCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:1035 PIPER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1449
Practice Address - Country:US
Practice Address - Phone:239-465-4157
Practice Address - Fax:239-354-7603
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018044363A00000X
FLPA9111294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9950128OtherAETNA
FLY0J29OtherBCBS OF FL
FL009562300Medicaid
FL009562300Medicaid
FLY0J29OtherBCBS OF FL
FL9950128OtherAETNA
FLQ47315Medicare UPIN