Provider Demographics
NPI:1649748393
Name:PENA, JOANNA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 BAYMEADOWS RD E STE 6
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9110
Mailing Address - Country:US
Mailing Address - Phone:904-731-1770
Mailing Address - Fax:
Practice Address - Street 1:7711 BAYMEADOWS RD E STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9110
Practice Address - Country:US
Practice Address - Phone:904-731-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9337542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily