Provider Demographics
NPI:1780857284
Name:TWOMBLY, JOANNA DUANE (DO)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:DUANE
Last Name:TWOMBLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 N FEDERAL HWY STE 800
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1409
Mailing Address - Country:US
Mailing Address - Phone:800-586-5022
Mailing Address - Fax:866-889-7835
Practice Address - Street 1:5109 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-907-6300
Practice Address - Fax:509-907-6310
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3556207V00000X
AR06-1833974207V00000X
OH34-009177207V00000X
MELT22014207V00000X
WAOP61394894207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR197028003Medicaid
AR267325YJL4OtherMEDICARE PTAN