Provider Demographics
NPI:1760768881
Name:KELLY, JOANNA E (CRNA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:E
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:95429 BARNWELL RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1698
Mailing Address - Country:US
Mailing Address - Phone:904-321-3533
Mailing Address - Fax:517-787-7365
Practice Address - Street 1:95429 BARNWELL RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1698
Practice Address - Country:US
Practice Address - Phone:904-321-3533
Practice Address - Fax:517-787-7365
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9330786367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered