Provider Demographics
NPI:1760011134
Name:JENSEN, JOANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CLEVELAND CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8925
Mailing Address - Country:US
Mailing Address - Phone:727-204-7383
Mailing Address - Fax:
Practice Address - Street 1:1115 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-1721
Practice Address - Country:US
Practice Address - Phone:386-698-4922
Practice Address - Fax:386-698-4903
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist