Provider Demographics
NPI:1821441536
Name:KLEPACH, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:KLEPACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NEBRASKA AVE STE 2-E
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4866
Mailing Address - Country:US
Mailing Address - Phone:772-461-6812
Mailing Address - Fax:
Practice Address - Street 1:2215 NEBRASKA AVE STE 2-E
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4866
Practice Address - Country:US
Practice Address - Phone:772-461-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9319595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily