Provider Demographics
NPI:1184330060
Name:PAYNE, JOANNE RAE (RN CERTIFIED CAPPA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:RAE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RN CERTIFIED CAPPA
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN BSN DOULA CLD
Mailing Address - Street 1:441 PONTEVEDRA RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-2545
Mailing Address - Country:US
Mailing Address - Phone:708-772-5031
Mailing Address - Fax:
Practice Address - Street 1:441 PONTEVEDRA RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-2545
Practice Address - Country:US
Practice Address - Phone:708-772-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSSNMedicaid