Provider Demographics
NPI:1104080761
Name:HALL, JOELLA CAULEY (ARNP)
Entity type:Individual
Prefix:
First Name:JOELLA
Middle Name:CAULEY
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 PEAR AVE
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-4887
Mailing Address - Country:US
Mailing Address - Phone:386-793-6628
Mailing Address - Fax:386-437-5912
Practice Address - Street 1:3760 PEAR AVE
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-4887
Practice Address - Country:US
Practice Address - Phone:386-793-6628
Practice Address - Fax:386-437-5912
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9216912363LF0000X
KY3008318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01277790OtherRAILROAD MEDICARE
KYK088380Medicare PIN
KYP01277790OtherRAILROAD MEDICARE
KYK088381Medicare PIN
KYK088382Medicare PIN