Provider Demographics
NPI:1013665777
Name:AKINS-EZELL, JOANN
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:AKINS-EZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E JACKSON ST STE 3300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5228
Mailing Address - Country:US
Mailing Address - Phone:866-277-3679
Mailing Address - Fax:
Practice Address - Street 1:600 WINDGATE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4881
Practice Address - Country:US
Practice Address - Phone:817-939-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35142333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy