Provider Demographics
NPI:1942774971
Name:ARCHIBAL, JOELLE VANESSA (RN-BSN)
Entity Type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:VANESSA
Last Name:ARCHIBAL
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 541801
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33454-1801
Mailing Address - Country:US
Mailing Address - Phone:561-530-9686
Mailing Address - Fax:
Practice Address - Street 1:4656 VILLAS SANTORINI DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-5098
Practice Address - Country:US
Practice Address - Phone:561-530-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9477621163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty